Outcomes with orbital and rotational atherectomy for inpatient percutaneous coronary intervention
Presenter
Michael S Megaly, M.D., FSCAI, Henry Ford Hospital, Bossier City, LA
Michael S Megaly, M.D., FSCAI, Henry Ford Hospital, Bossier City, LA, Emmanouil S. Brilakis, MD, PhD, FSCAI, Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, Ramy Sedhom, M.D., Loma Linda University Medical Center, Loma Linda, CA, Mariam Tawadros, MD, Ain Shams University Faculty of Medicine, Cairdo, Egypt, Ayman Elbadawi, MD, The University of Texas Medical Branch, Galveston, TX, Amgad Mentias, M.D., Cleveland Clinic, Cleveland, OH, Khaldoon Alaswad, M.D., FSCAI, Henry Ford Hospital, Detroit, MI, Ajay J. Kirtane, M.D., FSCAI, NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, Santiago Garcia, M.D., FSCAI, The Christ Hospital Health Network, Cincinnati, OH and Ashish Pershad, M.D., FSCAI, Chandler regional hospital, Chandler, AZ
Background
:
Data on the use of orbital vs. rotational atherectomy in contemporary inpatient percutaneous coronary intervention (PCI) is limited.
Methods
:
We queried the Nationwide Readmission Database (NRD) from January to November for years 2016-2017 to identify hospitalizations of patients who underwent PCI with atherectomy. We conducted a multivariate regression analysis to identify variables independently associated with in-hospital mortality
Results
:
We included 77,040 records who underwent inpatient PCI with atherectomy. Of those, 71,610 (93%) had RA, and 5,430 (7%) had OA. There was no significant change in the trend of using OA or RA over 2016 and 2017. OA was less utilized in patients presenting with STEMI (4.3% vs, 46.8%, p<0.001). In our cohort, OA was associated with lower in-hospital mortality (3.1% vs. 5%, p<0.001) and 30-day urgent readmission (<0.01% vs. 0.2%, p=0.009), but a higher risk of coronary perforation (1.7% vs. 0.6%, p<0.001) and cardiac tamponade (1% vs. 0.3%, p<0.001) and a higher cost of index hospitalization ($28,199 vs. $23,188, p<0.001) compared with RA.
Conclusions
:
Rotational atherectomy remains the predominant atherectomy modality for inpatient PCI in the United States (93%). There was no change in the trend of use of both modalities over years 2016 and 2017. Orbital atherectomy was associated with a lower incidence of in-hospital death, but with a higher risk of coronary perforation and a higher cost of the index hospitalization.
