Key result
Coronary atherectomy during PCI linked to ~39% higher in-hospital mortality versus no atherectomy.
Why the study?
Suboptimal stent delivery and deployment in calcified coronary lesions are associated with poor clinical outcomes.
Does coronary atherectomy improve in-hospital mortality and procedural outcomes in patients undergoing percutaneous coronary intervention?
Observational (n=2,035,039)
Yes
Does coronary atherectomy improve in-hospital mortality and procedural outcomes in patients undergoing percutaneous coronary intervention?
Effect estimate: aOR 1.39 (95% CI 1.31-1.46)
Absolute Event Rate: 3.3% vs 2.2%
p-value: p=<0.001
In a large US nationwide database, the use of coronary atherectomy during PCI was associated with higher in-hospital mortality and procedural complications compared to PCI without atherectomy, although concomitant IVUS imaging improved mortality.
Atherectomy during PCI was associated with higher mortality; this observational link leaves open causality and requires randomized confirmation.
BACKGROUND: Suboptimal stent delivery and deployment in calcified coronary lesions are associated with a poor clinical outcome. METHODS: Using the National Inpatient Sample database, we identified patients undergoing percutaneous coronary intervention (PCI). Comparison between procedural and hospital outcomes between patients who underwent atherectomy and those who did not. RESULTS: A total of 2,035,039 patients underwent PCI, of which 50,095 (2.4%) underwent lesion modification using atherectomy. After adjustment for baseline differences, patients who underwent atherectomy were found to have higher rates of in-hospital mortality (3.3% vs 2.2% adjusted Odds Ratio, aOR, 1.39; 95% confidence interval [CI], 1.31-1.46, P < 0.001), coronary artery dissection (1.7% vs 1.1%, aOR, 1.56; 95%, 1.45-1.67, P < 0.001) vascular complications (1.6% vs 1.0%, aOR, 1.52; 95%, 1.42-1.64, P < 0.001), major bleeding (6.3% vs 4.7%, aOR, 1.24; 95%, 1.18-1.28, P < 0.001), and acute kidney injury (AKI) (10.9%vs 9.1%, aOR, 1.07; 95%, 1.04-1.11, P < 0.001) when compared with non-atherectomy patients. Concomitant intravascular ultrasound (IVUS) imaging improved mortality, while other complication rates were not affected by imaging. CONCLUSION: Coronary atherectomy was performed in patients with multiple comorbidities and was associated with higher in-hospital mortality and complications than the non-atherectomy group.
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Darmoch et al. (2021) conducted an observational in Percutaneous coronary intervention (PCI) (n=2,035,039). Coronary atherectomy vs. No atherectomy was evaluated on In-hospital mortality (aOR 1.39, 95% CI 1.31-1.46, p=<0.001). Coronary atherectomy during PCI was associated with higher in-hospital mortality compared to no atherectomy (3.3% vs 2.2%; aOR 1.39; 95% CI 1.31-1.46; P<0.001).
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