Megaly Michael, Brilakis E S, Sedhom Ramy, Tawadros Mariam, Elbadawi Ayman, Mentias Amgad, Alaswad Khaldoon, Kirtane Ajay J, Garcia Santiago, Pershad Ashish
Division of Cardiology, Banner University Medical Center, UA College of Medicine, Phoenix, AZ, USA.
Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA.
Cardiol Ther. 2021 Jun;10(1):229-239. doi: 10.1007/s40119-021-00214-w. Epub 2021 Mar 12.
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.
我们的目标是描述在美国住院患者经皮冠状动脉介入治疗（PCI）中使用轨道旋磨术（OA）与旋切术（RA）的当代疗效。关于当代住院患者PCI中使用OA与RA的数据有限。
我们查询了2016 - 2017年1月至11月的全国再入院数据库（NRD），以确定接受旋磨术PCI治疗的患者住院情况。我们进行了多变量回归分析，以确定与住院死亡率相关的变量。
我们纳入了77040例接受住院PCI旋磨术患者的记录。其中，71610例（93%）接受了RA，5430例（7%）接受了OA。2016年和2017年期间，使用OA或RA的趋势没有显著变化。ST段抬高型心肌梗死（STEMI）患者中OA的使用率较低（4.3%对46.8%，p < 0.001）。在我们的队列中，OA与较低的住院死亡率（3.1%对5%，p < 0.001）和30天紧急再入院率（< 0.01%对0.2%，p = 0.009）相关，但与RA相比，冠状动脉穿孔风险更高（1.7%对0.6%，p < 0.001）、心包填塞风险更高（1%对0.3%，p < 0.001）且首次住院费用更高（28199美元对23188美元，p < 0.001）。
在美国，RA仍然是住院患者PCI中主要的旋磨术式（93%）。2016年和2017年期间，两种术式的使用趋势均无变化。对于总体未匹配队列，OA的住院死亡率较低，但冠状动脉穿孔风险较高且首次住院费用较高。
