Key result
Hospital PCI volume shows no association with in-hospital mortality after rotational atherectomy for ACS.
Why the study?
ACS is considered a relative contraindication to coronary atherectomy, but consensus documents do not preclude its use, prompting investigation into its utilization and outcomes.
Does hospital PCI volume or on-site surgical backup affect in-hospital mortality in patients undergoing coronary atherectomy for acute coronary syndrome?
Observational (n=822,237)
Yes
Does hospital PCI volume or on-site surgical backup affect in-hospital mortality in patients undergoing coronary atherectomy for acute coronary syndrome?
Odds Ratio: 0.94 (95% CI 0.65–1.36)
p-value: p=.73
In patients with ACS undergoing PCI, coronary atherectomy is infrequently used, and in-hospital mortality is not significantly associated with hospital PCI volume or the presence of on-site surgical backup.
No volume-mortality association seen after rotational atherectomy in ACS; leaves open whether PCI volume or surgical backup influences outcomes.
Background Acute coronary syndrome (ACS) is considered a relative contraindication to coronary atherectomy; however, expert consensus documents do not preclude its use for ACS. We investigated the temporal trends and hospital variability in the utilization and outcomes of coronary atherectomy among patients with ACS undergoing percutaneous coronary intervention (PCI) using data from a Japanese nationwide registry. Methods First, we analyzed the temporal trend in the use of rotational atherectomy (RA) and orbital atherectomy during PCI for patients with ACS between 2014 and 2022 (822,237 PCI across 1269 hospitals). Next, we assessed the outcomes of the patients who underwent RA for ACS between 2019 and 2022 (7421 PCI across 662 hospitals). The primary outcome was in-hospital mortality after PCI. We also evaluated the effects of PCI volumes and the 2020 policy change in Japan that allowed operators to perform coronary atherectomy at low PCI volume hospitals (<200 PCI/y) without on-site surgical backup on outcomes. Results The overall usage rates of RA and orbital atherectomy for ACS were low, at 2.0% and 0.8%, respectively. RA for ACS was never performed at 581 hospitals (46%). After adjusting for the baseline characteristic, in-hospital mortality after RA for ACS was not significantly associated with hospital PCI volumes (odds ratio, 0.94; 95% CI, 0.65-1.36; P = .73 for highest vs lowest tertiles) or the initiation of coronary atherectomy after the policy change (odds ratio, 0.99; 95% CI, 0.63-1.51; P = .95). Conclusions Coronary atherectomy for ACS is infrequently performed in Japan. PCI volume and on-site surgical backup were not significantly associated with in-hospital mortality after coronary atherectomy for ACS.
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Aikawa et al. (2025) conducted an observational in Acute coronary syndrome (n=822,237). Highest tertile of hospital PCI volume vs. Lowest tertile of hospital PCI volume was evaluated on In-hospital mortality after PCI (OR 0.94, 95% CI 0.65-1.36, p=.73). In-hospital mortality after rotational atherectomy for acute coronary syndrome was not significantly associated with hospital PCI volumes (OR 0.94; 95% CI 0.65-1.36; P=0.73 for highest vs lowest tertiles).
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