Effect of Operator Experience Performing Rotational Atherectomy on Clinical Outcomes After Percutaneous Coronary Intervention

Abstract

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.

Keywords: Coronary artery disease; Percutaneous coronary intervention; Rotational atherectomy.

Figure 1. Comparison of 1-year MACE between the more and less experienced groups, in the (A) unmatched population and (B) propensity score matched population.

CI = confidence interval; HR = hazard ratio; MACE = major adverse cardiac events.

Figure 2. Comparison of the complication incidence between the more and less experienced groups in the unmatched and propensity score matched populations.

CI = confidence interval; HR = hazard ratio.