January 24, 2020

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 lower risk of major adverse events that was counterbalanced by 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 utilization of either rotational or orbital CA.

The investigators evaluated intervals using the date of index CA grouped into time periods (2009 Q3 to 2010; 2011 to 2012; 2013 to 2014; and 2015 to 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, 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=1672), 577 (34.5%) did not perform any CA
  • Patients treated with CA were elderly, more often male, and had a history of diabetes, previous myocardial infarction, PCI, and coronary artery bypass grafting
  • Utilization of CA increased from 1.1% in Q3 2009 to 3.0% in Q4 of 2016
  • There was a 5% quarterly increase in odds of CA (odds ratio [CI], 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 myocardial infarction (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%, 1.04–1.35; P < .01), reported the investigators in Circulation: Cardiovascular Interventions.