Adverse Events Decrease as Use of Coronary Atherectomy For PCI Increases, NCDR Study Finds

Use of coronary atherectomy (CA) for PCI has increased over time and may be associated with a decreased risk of major adverse cardiovascular events, according to a study published Jan. 24 in Circulation: Cardiovascular Interventions.

Nirat Beohar, MD, FACC, et al., used data from ACC's CathPCI Registry to assess trends in frequency of CA use, hospital variability and outcomes with CA in patients undergoing PCI. The researchers used four time-based intervals, ranging from 2009 to 2016, to look at outcomes and patient and hospital variables over the study period.

Results showed that of the 3,864,377 patients who underwent PCI during the study period, 65,033 (1.7%) received a CA procedure. The rate of CA procedures increased from 1.1% of PCI volume in the first quartile in 2009 to 3% in the fourth quartile in 2016. Patients who underwent CA were more likely to be elderly, male and to have a history of diabetes, myocardial infarction (MI), PCI or CABG. In addition, there was a temporal decline in the study's primary outcome of in-hospital major adverse cardiovascular events – defined as a composite of all-cause mortality, periprocedural MI or stroke – (5.4% in 2009 vs. 4% in 2016) among patients undergoing CA throughout the study period.

Further, there was wide variation in CA use across hospitals, ranging from 0% to 19% of all PCI procedures. Higher hospital CA volume was associated with lower mortality and lower rates of PCI failure or complications requiring CABG, but was associated with a small increase in coronary perforation.

According to the researchers, use of CA is increasing, but the procedure is used infrequently in current clinical practice. They conclude that increased CA utilization for PCI is associated with a decrease in major adverse cardiovascular events or the need for emergency CABG.

In a related editorial comment, S. Chiu Wong, MD, FACC, writes that the "demand for percutaneous treatment of moderately to severely calcified lesions is only likely to rise" with an aging population. CA "eases equipment delivery and optimizes stent expansion," he notes adding that the study "emphasizes the importance of familiarity with all devices, old and new, and the catheterization laboratory."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Atherectomy, Coronary, Percutaneous Coronary Intervention, Myocardial Infarction, Coronary Artery Bypass, Registries, Stroke, Diabetes Mellitus, Stents, National Cardiovascular Data Registries, CathPCI Registry

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