Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Outcomes Research

Background:

• Contemporary data on orbital atherectomy (OA) versus rotational atherectomy (RA) use in inpatient percutaneous coronary intervention (PCI) in the United States is limited.
• Understanding the comparative outcomes of these atherectomy modalities is crucial for optimizing patient care.

Purpose of the Study:

• To describe the contemporary outcomes of OA compared to RA for inpatient PCI in the United States.
• To analyze trends in the utilization of OA and RA between 2016 and 2017.

Main Methods:

• A retrospective analysis of the Nationwide Readmission Database (NRD) from January to November 2016-2017.
• Inclusion of hospitalizations for patients undergoing PCI with atherectomy.
• Multivariate regression analysis to identify predictors of in-hospital mortality.

Main Results:

• Rotational atherectomy (RA) was predominantly used (93%) compared to orbital atherectomy (OA) (7%).
• Orbital atherectomy (OA) was associated with lower in-hospital mortality (3.1% vs. 5%) and 30-day urgent readmissions.
• Orbital atherectomy (OA) demonstrated a higher risk of coronary perforation (1.7% vs. 0.6%) and cardiac tamponade (1% vs. 0.3%), along with increased hospitalization costs ($28,199 vs. $23,188).

Conclusions:

• Rotational atherectomy (RA) remains the dominant atherectomy device for inpatient PCI in the US.
• Orbital atherectomy (OA) offers reduced in-hospital mortality but carries increased risks of procedural complications and higher index hospitalization costs.
• Utilization trends for both OA and RA remained stable between 2016 and 2017.