Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
Scientific Affairs, Cardiovascular Systems Inc, St. Paul, MN, USA.
Cardiovasc Revasc Med. 2023 Aug;53:13-19. doi: 10.1016/j.carrev.2023.03.008. Epub 2023 Mar 24.
Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS.
The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data.
Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 %, 2.3 %, and 9.1 % were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts ($34,340.77 in OA, $32,306.2 in non-OA) as compared to the PCI-only cohort ($23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI.
This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.
患有主动脉瓣狭窄（AS）的患者通常伴有钙化的冠状动脉疾病（CAD），需要进行旋磨术以改善病变顺应性和经皮冠状动脉介入治疗（PCI）的成功率。然而，关于 AS 患者行 PCI 加或不加旋磨术的数据却很少。
利用国际疾病分类第 10 次修订版（ICD-10）编码，从 2016 年至 2019 年，对国家住院患者样本（NIS）数据库进行了查询，以确定接受 PCI 加或不加旋磨术（轨道旋磨术[OA]、旋转或激光旋磨术[非-OA]）治疗的 AS 患者。使用出院加权数据评估了时间趋势、安全性、结果、费用以及主要不良心血管事件（MACE）的相关性。
共确定了 45420 例接受 PCI 加或不加旋磨术治疗的 AS 患者，其中 88.6%、2.3%和 9.1%分别接受了单纯 PCI、OA 和非-OA 治疗。行 PCI 的患者数量有所增加（从 8855 例增加至 10885 例），旋磨术[OA（从 165 例增加至 300 例）和非-OA（从 795 例增加至 1255 例）]以及血管内超声（IVUS）的应用也有所增加（从 625 例增加至 1000 例）。OA 组（34340.77 美元）和非-OA 组（32306.2 美元）的住院费用中位数均高于单纯 PCI 组（23683.98 美元）。与 IVUS 指导下的 PCI 相比，接受 IVUS 指导的旋磨术和 PCI 的患者发生 MACE 的可能性较小。
本大数据研究揭示了 2016 年至 2019 年，AS 患者行 PCI 加或不加旋磨术的数量显著增加。考虑到 AS 患者的复杂合并症，不同组之间的总体并发症发生率分布均匀，表明在 AS 患者中，IVUS 指导下的 PCI 加或不加旋磨术是可行且安全的。
