Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention.
Atherectomy
Orbital atherectomy
Rotational atherectomy
Journal
Cardiology and therapy
ISSN: 2193-8261
Titre abrégé: Cardiol Ther
Pays: England
ID NLM: 101634495
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
15
12
2020
accepted:
29
01
2021
pubmed:
13
3
2021
medline:
13
3
2021
entrez:
12
3
2021
Statut:
ppublish
Résumé
Our objective was to describe the contemporary outcomes of orbital atherectomy (OA) vs. rotational atherectomy (RA) use for inpatient percutaneous coronary intervention (PCI) in the United States. Data on the use of OA vs. RA in contemporary inpatient PCI are limited. We queried the Nationwide Readmission Database (NRD) from January to November for the years 2016-2017 to identify hospitalizations of patients who underwent PCI with atherectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality. We included 77,040 records of patients who underwent inpatient PCI with atherectomy. Of those, 71,610 (93%) had RA, and 5430 (7%) had OA. There was no significant change in the trend of using OA or RA over 2016 and 2017. OA was less utilized in patients presenting with ST-segment elevation myocardial infarction (STEMI) (4.3% vs. 46.8%, p < 0.001). In our cohort, OA was associated with lower in-hospital mortality (3.1% vs. 5%, p < 0.001) and 30-day urgent readmission (< 0.01% vs. 0.2%, p = 0.009), but a higher risk of coronary perforation (1.7% vs. 0.6%, p < 0.001) and cardiac tamponade (1% vs. 0.3%, p < 0.001) and a higher cost of index hospitalization ($28,199 vs. $23,188, p < 0.001) compared with RA. RA remains the predominant atherectomy modality for inpatient PCI in the United States (93%). There was no change in the trend of use for either modality over the years 2016 and 2017. OA was noted to have a lower incidence of in-hospital death, but a higher risk of coronary perforation and a higher cost of index hospitalization for the overall unmatched cohorts.
Identifiants
pubmed: 33710602
doi: 10.1007/s40119-021-00214-w
pii: 10.1007/s40119-021-00214-w
pmc: PMC8126522
doi:
Types de publication
Journal Article
Langues
eng
Pagination
229-239Références
Lee MS, Shah N. The impact and pathophysiologic consequences of coronary artery calcium deposition in percutaneous coronary interventions. J Invasive Cardiol. 2016;28:160–7.
pubmed: 26301561
Mosseri M, Satler LF, Pichard AD, Waksman R. Impact of vessel calcification on outcomes after coronary stenting. Cardiovasc Revasc Med. 2005;6:147–53.
doi: 10.1016/j.carrev.2005.08.008
Colombo A, Stankovic G. Coronary perforations: old screenplay, new actors! J Invasive Cardiol. 2004;16:302–3.
pubmed: 15155998
Lee MS, Yang T, Lasala J, Cox D. Impact of coronary artery calcification in percutaneous coronary intervention with paclitaxel-eluting stents: Two-year clinical outcomes of paclitaxel-eluting stents in patients from the ARRIVE program. Catheter Cardiovasc Interv. 2016;88:891–7.
doi: 10.1002/ccd.26395
Ali ZA, Nef H, Escaned J, Werner N, Banning AP, Hill JM, Bruyne BD, Montorfano M, Lefevre T, Stone GW, Crowley A, Matsumura M, Maehara A, Lansky AJ, Fajadet J, Mario CD. Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses. Circ Cardiovasc Interv. 2019;12:e008434.
doi: 10.1161/CIRCINTERVENTIONS.119.008434
Sharma SK, Tomey MI, Teirstein PS, Kini AS, Reitman AB, Lee AC, Généreux P, Chambers JW, Grines CL, Himmelstein SI, Thompson CA, Meredith IT, Bhave A, Moses JW. North American expert review of rotational atherectomy. Circ Cardiovasc Interv. 2019;12:e007448.
doi: 10.1161/CIRCINTERVENTIONS.118.007448
Tomey MI, Sharma SK. Interventional options for coronary artery calcification. Curr Cardiol Rep. 2016;18:12.
doi: 10.1007/s11886-015-0691-8
Sotomi Y, Shlofmitz RA, Colombo A, Serruys PW, Onuma Y. Patient selection and procedural considerations for coronary orbital atherectomy system. Interv Cardiol Rev. 2016;11:33.
doi: 10.15420/icr.2015:19:2
Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695–705.
doi: 10.1056/NEJMoa1814052
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998. https://doi.org/10.1097/00005650-199801000-00004
doi: 10.1097/00005650-199801000-00004
pubmed: 9599597
Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, Chan PS, Krumholz HM. Adherence to methodological standards in research using the national inpatient sample. JAMA. 2017;318:2011–8.
doi: 10.1001/jama.2017.17653
12Houchens R, Elixhauser A. Using the HCUP nationwide inpatient sample to estimate trends (updated for 1988–2004). HCUP Method Series Report 2006; 5.
Shiode N, Kozuma K, Aoki J, Awata M, Nanasato M, Tanabe K, Yamaguchi J, Kusano H, Nie H, Kimura T. The impact of coronary calcification on angiographic and 3-year clinical outcomes of everolimus-eluting stents: results of a XIENCE V/PROMUS post-marketing surveillance study. Cardiovasc Interv Therap. 2018;33:313–20.
doi: 10.1007/s12928-017-0484-7
Abdel-Wahab M, Richardt G, Büttner HJ, Toelg R, Geist V, Meinertz T, Schofer J, King L, Neumann F-J, Khattab AA. High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial. JACC Cardiovasc Interv. 2013;6:10–9.
doi: 10.1016/j.jcin.2012.07.017
Lee M, Généreux P, Shlofmitz R, Phillipson D, Anose BM, Martinsen BJ, Himmelstein SI, Chambers JW. Orbital atherectomy for treating de novo, severely calcified coronary lesions: 3-year results of the pivotal ORBIT II trial. Cardiovasc Revasc Med. 2017;18:261–4.
doi: 10.1016/j.carrev.2017.01.011
Meraj PM, Shlofmitz E, Kaplan B, Jauhar R, Doshi R. Clinical outcomes of atherectomy prior to percutaneous coronary intervention: A comparison of outcomes following rotational versus orbital atherectomy (COAP-PCI study). J Interv Cardiol. 2018;31:478–85.
doi: 10.1111/joic.12511
Goel S, Pasam RT, Chava S, Gotesman J, Sharma A, Malik BA, Frankel R, Shani J, Gidwani U, Latib A. Orbital atherectomy versus rotational atherectomy: A systematic review and meta-analysis. Int J Cardiol. 2020;303:16–21.
doi: 10.1016/j.ijcard.2019.12.037
Kini AS, Vengrenyuk Y, Pena J, Motoyama S, Feig JE, Meelu OA, Rajamanickam A, Bhat AM, Panwar S, Baber U, Sharma SK. Optical coherence tomography assessment of the mechanistic effects of rotational and orbital atherectomy in severely calcified coronary lesions. Catheter Cardiovasc Interv. 2015;86:1024–32.
doi: 10.1002/ccd.26000
Chambers JW, Diage T. Evaluation of the Diamondback 360 coronary orbital atherectomy system for treating de novo, severely calcified lesions. Expert Rev Med Devices. 2014;11:457–66.
doi: 10.1586/17434440.2014.929493
Megaly M, Brilakis ES. Primary orbital atherectomy for treating a heavily calcified balloon uncrossable lesion. Cardiovasc Revasc Med. 2020 Feb 8. In press.
Pietzsch JB, Geisler BP, Ikeno F. Cost-effectiveness of orbital atherectomy compared to rotational atherectomy in treating patients with severely calcified coronary artery lesions in Japan. Cardiovasc Interv Therap. 2018;33:328–36.
doi: 10.1007/s12928-017-0488-3
Garrison LP Jr, Zimmermann MR, Young CH, Crittendon J, Genereux P. Cost-effectiveness analysis of the orbital atherectomy system: two-year follow-up. Cardiovasc Revasc Med. 2017;18:86–90.
doi: 10.1016/j.carrev.2016.12.005