Study From CathPCI Registry Analyzes Trends in Usage and Outcomes of Coronary Atherectomy

January 24, 2020—Nirat Beohar, MD, et al conducted a study that sought to assess the trends in usage, interhospital variability, and outcomes with coronary atherectomy (CA) among patients undergoing percutaneous coronary intervention (PCI). The findings were published as a report from the National Cardiovascular Data Registry CathPCI Registry online ahead of print in Circulation: Cardiovascular Interventions.

The investigators concluded after accounting for potential confounders, higher CA volume was associated with a lower risk of major adverse events that were counterbalanced by a small risk of coronary perforation. They noted that although CA is performed infrequently, its use has increased over time.

As described in Circulation: Cardiovascular Interventions, the study included all patients undergoing PCI in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009 to December 31, 2016 (N = 3,864,377). The patients were analyzed based on the utilization of either rotational or orbital CA.

The investigators evaluated intervals using the date of index CA grouped into time periods (2009 Q3–2010; 2011–2012; 2013–2014; and 2015–2016) and hospital-level quartiles based on annual CA volumes. The primary outcome measure was in-hospital major adverse cardiac events defined as a composite of all-cause mortality, periprocedural myocardial infarction (MI), or stroke. They then determined the independent variables associated with outcomes.

In Circulation: Cardiovascular Interventions, the investigators reported the following on usage:

• CA represented 1.7% (n = 65,033) of the total PCI volume
• Among hospitals performing PCI (n = 1,672), 577 (34.5%) did not perform any CA
• Patients treated with CA were elderly, more often male, and had a history of diabetes, previous MI, PCI, and coronary artery bypass grafting
• Utilization of CA increased from 1.1% in Q3 2009 to 3% in Q4 of 2016
• There was a 5% quarterly increase in odds of CA (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.04–1.06; P < .001).

Regarding outcomes, they found that among patients undergoing CA, there was a temporal decline in major adverse cardiac events (OR, 0.98; 95% CI, 0.97–0.99; P < .001) and MI (OR, 0.97; 95% CI, 0.96–0.98; P < .001).

In adjusted analyses, increasing hospital CA volume was associated with lower mortality (OR, 0.85; 95% CI, 0.76–0.96; P = .01) and lower rates of PCI failure or complication requiring coronary artery bypass grafting (OR, 0.67; 95% CI, 0.56–0.79; P < .001) but was associated with small increase in coronary perforation (OR, 1.18; 95% CI, 1.04–1.35; P < .01), reported the investigators in Circulation: Cardiovascular Interventions.