Key result
Higher operator experience (>82 prior cases) was not associated with a significant difference in 1-year cardiac death, MI, or target vessel revascularization (7.3% vs 5.2%; HR 1.46; 95% CI 0.57-3.74).
Why the study?
Rotational atherectomy is used to ablate calcified plaques, but whether operator experience with the technique influences clinical outcomes remained uncertain.
Does greater operator experience (>82 cases) improve the composite of cardiac death, myocardial infarction, and target vessel revascularization at 1 year in patients undergoing PCI with rotational atherectomy for calcified lesions?
Observational (n=497)
Yes
Does greater operator experience (>82 cases) improve the composite of cardiac death, myocardial infarction, and target vessel revascularization at 1 year in patients undergoing PCI with rotational atherectomy for calcified lesions?
Operator experience (>82 cases) with rotational atherectomy does not significantly impact 1-year hard clinical outcomes, though it is associated with reduced fluoroscopy time and increased use of intravascular imaging.
Answers are grounded in this paper and cite their sources.
No support for experience thresholds in rotational atherectomy PCI; leaves open volume effects on procedural metrics in prospective cohorts.
BACKGROUND AND OBJECTIVES: Rotational atherectomy (RA) is a technique used to ablate calcified plaques. There is speculation that operators' experience with RA could play a role in the outcomes. METHODS: From December 2015 to April 2020, patients with calcified coronary lesions requiring percutaneous coronary intervention (PCI) with RA were enrolled in a prospective, multicenter, observational registry. The patients were divided into two groups based on the number of RAs performed by their operator in the past. A propensity score matching was done for a sensitivity analysis. The primary outcome was a composite of cardiac death, myocardial infarction, and target vessel revascularization at 1 year. RESULTS: A total of 497 patients were enrolled in the study. The calculated cutoff number of RA-PCI between the two groups was 82 cases. The more experienced group underwent PCI with less fluoroscopy time (less experienced vs. more experienced, 38.8 vs. 30.0 minutes, p<0.001), and more frequent intravascular imaging (54.6% vs. 69.0%, p=0.012). The primary outcome did not differ significantly between the groups (5.2% vs. 7.3%, hazard ratio, 1.46; 95% confidence interval [CI], 0.57-3.74; p=0.433). No significant difference in the incidence of complications was observed between the groups (5.5% vs. 7.0%, odds ratio, 1.38; 95% CI, 0.57-3.04; p=0.526). Similar results were observed in the propensity-score matched population. CONCLUSIONS: In PCI using RA for calcified lesions, the composite outcome of cardiac death, myocardial infarction, and target vessel revascularization at 1 year was not significantly different according to RA experience among operators.
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Kwon et al. (2025) conducted an observational in Calcified coronary lesions requiring percutaneous coronary intervention with rotational atherectomy (n=497). Higher operator experience (>82 prior cases) vs. Lower operator experience (≤82 prior cases) was evaluated on Composite of cardiac death, myocardial infarction, and target vessel revascularization at 1 year (HR 1.46, 95% CI 0.57-3.74, p=0.433). Higher operator experience (>82 prior cases) was not associated with a significant difference in 1-year cardiac death, MI, or target vessel revascularization (7.3% vs 5.2%; HR 1.46; 95% CI 0.57-3.74).
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