Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention

Michael Megaly, E. S. Brilakis, Ramy Sedhom, Mariam Tawadros, Ayman Elbadawi, Amgad Mentias, Khaldoon Alaswad, Ajay J. Kirtane, Santiago Garcia, Ashish Pershad

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)229-239
Number of pages11
JournalCardiology and Therapy
Volume10
Issue number1
DOIs
StatePublished - Jun 2021
Externally publishedYes

Keywords

  • Atherectomy
  • Orbital atherectomy
  • Rotational atherectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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