Impact of debulking devices in percutaneous coronary intervention for acute myocardial infarction with severely calcified lesions: a retrospective analysis

Background Although advancements in percutaneous coronary intervention (PCI) techniques have reduced in-hospital mortality for acute myocardial infarction (AMI) in Japan, treating AMI caused by severely calcified lesions remains challenging. The effectiveness of debulking devices in PCI for AMI with severely calcified culprit lesions remains unclear. Purpose To elucidate the impact of debulking device use on outcomes and prognosis in PCI for AMI. Methods A retrospective analysis was conducted using data from AMI patients registered in the Tokyo CCU Network database between 2018 and 2022, with confirmed records of debulking device use (n=23,068). Of these, 20,484 patients underwent PCI after excluding those with missing admission/discharge dates or unclear vital status (alive or deceased). Among the 20,484 patients, 15,122 were classified as STEMI and 5,362 as NSTEMI. Patients who underwent rotational and/or orbital atherectomy were categorized into the debulking group (n=74), while the remaining patients were classified into the non-debulking group (n=20,410). Results Regarding patient demographics, the debulking group was significantly older (78 ± 9 years vs. 69 ± 13 years, p<0.001) and had a higher proportion of women (37.8% vs. 22.4%, p=0.003). This group also had significantly higher rates of diabetes, hypertension, hyperlipidemia, atrial fibrillation, prior myocardial infarction, prior stroke, peripheral artery disease, and previous revascularization procedures. In terms of PCI procedures, there were no significant differences in the use of intravascular imaging (100% vs. 95.1%, p=0.052), mechanical circulatory support devices (24.3% vs. 15.7%, p=0.053), or achievement of post-procedural TIMI flow grade 3 (89.2% vs. 89.3%, p=1.00). Additionally, there were no significant differences in complication rates (14.9% vs. 9.3%, p=0.108), short-term prognosis (in-hospital mortality: 6.8% vs. 5.7%, p=0.613), or hospitalization duration (22 ± 51 days vs. 31 ± 2301 days, p=0.972). Conclusions Although it is not uncommon for the culprit lesion in AMI to be a severely calcified lesion, the use of debulking devices in the acute setting is limited and warrants further study. This study suggests that the use of debulking devices in the acute setting is unlikely to worsen PCI outcomes and may be acceptable.