Japanese PCI Registry Reports on Incidence and Determinants of Complications in Rotational Atherectomy

November 14, 2016—Kenichi Sakakura, MD, et al published findings from an investigation of the incidence and determinants of complications in rotational atherectomy (RA) in percutaneous coronary intervention (PCI) using a large nationwide registration system in Japan (J-PCI). The findings are available online ahead of print in Circulation: Cardiovascular Interventions.

The investigators noted that the use of RA is growing because of the expanded indication for PCI to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality.

As summarized in Circulation: Cardiovascular Interventions, the primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. The investigators analyzed 13,335 RA patients (3.2% of registered PCI cases). The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.6%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). 

The investigators found that the clinical variables associated with the occurrence of the composite outcome were age (odds ratio [OR], 1.03 per unit increment; 95% confidence interval [CI], 1.02–1.05), impaired kidney function (OR, 1.59; 95% CI, 1.15–2.19), previous myocardial infarction (OR, 1.69; 95% CI, 1.21–2.35), emergent PCI (OR, 4.02; 95% CI, 1.66–8.27), and triple-vessel disease (vs single-vessel disease: OR, 2.17; 95% CI, 1.43–3.28). 

Notably, the investigators reported that the institutional volume of RA cases was inversely associated with the composite outcomes (high-volume vs low-volume institution: OR 0.56; 95% CI, 0.36–0.89).

The reported incidence of the important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA), concluded the investigators in Circulation: Cardiovascular Interventions.