Key result
Rotational atherectomy was associated with a significantly higher risk of in-hospital pericardial effusion (RR 2.69) and bleeding compared to modified balloon angioplasty, while adjusted MACCE rates were similar.
Why the study?
Modified balloons and rotational atherectomy are recommended for treating coronary plaques with superficial calcium, but knowledge about their in-hospital safety is limited.
Does rotational atherectomy compared to modified balloon angioplasty increase the risk of in-hospital procedural complications in patients with coronary artery disease?
Cohort (n=32,470)
Yes
Does rotational atherectomy compared to modified balloon angioplasty increase the risk of in-hospital procedural complications in patients with coronary artery disease?
In a real-world German registry, rotational atherectomy was associated with a higher risk of in-hospital bleeding and pericardial complications compared to modified balloon angioplasty, though MACCE rates were similar.
May warrant modified balloon angioplasty preference to limit complications; leaves open optimal strategy pending randomized trials.
BACKGROUND: Modified balloons (MB) and rotational atherectomy (RA) are recommended tools for treatment of coronary plaques with superficial calcium. Knowledge about in-hospital safety is limited. METHODS: Patients with coronary artery disease who underwent coronary angiography with RA or MB angioplasty in Germany were identified via ICD and OPS codes from 2017 to 2020. Acute coronary syndromes were excluded. Since patients were not randomized toward MB or RA, potential confounding factors were taken into account using the propensity score methods. Thereby, inverse probability weighting was applied. RESULTS: Ten thousand.ninety-twopatients underwent RA with an increasing trend from 1817 in 2017 toward 3166 in 2020. MBs were used in 22,378 patients also with an increasing trend from 4771 in 2017 toward 6078 in 2020. Patients receiving RA were older (74.23 ± 8.68 vs. 71.86 ± 10.02, p < 0.001), had a higher Charlson Comorbidity Index (2.07 ± 1.75 vs. 1.99 ± 1.76, p = 0.001) and more frequently left main (17.96% vs. 12.91%, p < 0.001) or three vessel disease (66.25% vs. 58.10%, p < 0.001). Adjusted procedural risk of major adverse cardiac and cerebrovascular events (MACCE) was similar in both groups, while pericardial effusion (RR 2.69; 95% CI 1.88-3.86, p < 0.001), pericardial puncture/pericardiotomy/pericardial tamponade (RR 2.66; 95% CI 1.85-3.81, p < 0.001) and bleeding (RR 1.65; 95% CI 1.12-2.43, p < 0.011) occurred more frequently in patients receiving RA. Patients treated with RA at high volume centers were hospitalized shorter (p = 0.005) and had a lower rate of acute cerebrovascular events (p < 0.001). Rate of MACCE, bleeding and pericardial puncture were not influenced by the annual RA numbers per center. CONCLUSION: MBs had a lower risk of bleeding and pericardial puncture. Patients treated at centers with high annual RA procedure numbers had a lower risk of acute cerebrovascular events and were hospitalized shorter.
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Maier et al. (2024) conducted a cohort in Coronary artery disease (n=32,470). Rotational atherectomy vs. Modified balloon angioplasty was evaluated on Pericardial effusion (RR 2.69, 95% CI 1.88-3.86, p=<0.001). Rotational atherectomy was associated with a significantly higher risk of in-hospital pericardial effusion (RR 2.69) and bleeding compared to modified balloon angioplasty, while adjusted MACCE rates were similar.
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