Temporal Trends and Outcomes of Percutaneous Coronary Atherectomy in the United States

Background. There is paucity of data regarding the temporal trends and outcomes of coronary atherectomy in the United States. Methods. We queried the National Inpatient Sample database (2011-2016) for hospitalizations of patients undergoing coronary atherectomy procedures. We also compared outcomes of non-orbital vs orbital coronary atherectomy in a more contemporary cohort. Results. Our analysis included 2,990,223 hospitalizations with PCI, of which 114,462 (3.8%) included an atherectomy procedure. A significant increase in coronary atherectomy procedures was observed over time (0.66% in 2011 vs 8.9% in 2016; P-trend=.04). There was an increase in in-hospital mortality associated with atherectomy procedures from 3.2% in 2011 to 4.7% in 2016 (P-trend=.04), which paralleled the increase in patient comorbidities, use of mechanical circulatory devices (P-trend<.001), and procedural complications. While several predictors of increased mortality after an atherectomy procedure were identified, the use of intravascular ultrasound (IVUS) was associated with lower mortality during atherectomy procedures (adjusted odds ratio [OR] = 0.61; 95% confidence interval [CI], 0.42-0.89), although its overall use was low (10.4%). Compared with other atherectomy procedures, orbital atherectomy was associated with lower in-hospital mortality (3.2% vs 4.7%; adjusted OR = 0.50; 95% CI, 0.30-0.81). Conclusion. Our large national database analysis demonstrates an increase in the number of coronary atherectomy procedures and in their in-hospital mortality and complications over time. Orbital atherectomy appears to be associated with favorable outcomes compared with non-orbital atherectomy, and IVUS use was associated with lower mortality during atherectomy procedures. These associations do not necessarily imply causality and need to be confirmed in future randomized clinical trials.