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Trends in Usage and Clinical Outcomes of Coronary Atherectomy: A Report From the National Cardiovascular Data

Nirat Beohar1,2, Lisa A Kaltenbach3, Daniel Wojdyla3

  • 1NewYork-Presbyterian Hospital/Columbia University Medical Center (N.B., M.B.L., J.W.M., A.J.K.).

Circulation. Cardiovascular Interventions
|January 25, 2020
PubMed

Insights

Coronary atherectomy (CA) use increased from 2009-2016, with higher hospital volumes linked to fewer major adverse cardiac events. However, increased CA use also correlated with a small rise in coronary perforation risk.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Adjunctive coronary atherectomy (CA) is used for severe calcified coronary lesions.
  • Temporal trends, patient selection, and use variation of CA remain underdescribed.
  • Understanding CA utilization patterns is crucial for optimizing percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To assess temporal trends in coronary atherectomy (CA) utilization.
  • To evaluate interhospital variability in CA use.
  • To determine the outcomes associated with CA in patients undergoing percutaneous coronary intervention (PCI).

Main Methods:

  • Analysis of 3,864,377 patients undergoing PCI in the CathPCI Registry (July 2009–December 2016).
  • Stratification of CA utilization by time intervals and hospital annual CA volumes.
  • Primary outcome: in-hospital major adverse cardiac events (MACE) including mortality, myocardial infarction, or stroke.

Main Results:

  • Coronary atherectomy (CA) constituted 1.7% of PCI procedures, with utilization increasing from 1.1% to 3.0% between 2009 and 2016.
  • Higher hospital CA volumes were associated with reduced mortality and PCI failure/complication rates requiring coronary artery bypass grafting.
  • An increase in CA utilization correlated with a temporal decline in MACE and myocardial infarction, but also a slight increase in coronary perforation.

Conclusions:

  • Coronary atherectomy (CA) use is increasing despite infrequent application.
  • Higher institutional CA volume is linked to improved patient outcomes, including lower mortality and fewer complications.
  • The benefits of increased CA volume must be weighed against a small but significant risk of coronary perforation.
Abstract

Keywords:
atherectomycoronary artery bypassdiabetes mellitusmyocardial infarctionpercutaneous coronary intervention

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