Application and Outcomes of Coronary Atherectomy in Acute Coronary Syndrome: A Report From the J-PCI Registry.

BACKGROUND

Acute coronary syndrome (ACS) is considered a relative contraindication to coronary atherectomy; however, expert consensus documents do not preclude its use for ACS. We investigated the temporal trends and hospital variability in the utilization and outcomes of coronary atherectomy among patients with ACS undergoing percutaneous coronary intervention (PCI) using data from a Japanese nationwide registry.

METHODS

First, we analyzed the temporal trend in the use of rotational atherectomy (RA) and orbital atherectomy during PCI for patients with ACS between 2014 and 2022 (822,237 PCI across 1269 hospitals). Next, we assessed the outcomes of the patients who underwent RA for ACS between 2019 and 2022 (7421 PCI across 662 hospitals). The primary outcome was in-hospital mortality after PCI. We also evaluated the effects of PCI volumes and the 2020 policy change in Japan that allowed operators to perform coronary atherectomy at low PCI volume hospitals (<200 PCI/y) without on-site surgical backup on outcomes.

RESULTS

The overall usage rates of RA and orbital atherectomy for ACS were low, at 2.0% and 0.8%, respectively. RA for ACS was never performed at 581 hospitals (46%). After adjusting for the baseline characteristic, in-hospital mortality after RA for ACS was not significantly associated with hospital PCI volumes (odds ratio, 0.94; 95% CI, 0.65-1.36; = .73 for highest vs lowest tertiles) or the initiation of coronary atherectomy after the policy change (odds ratio, 0.99; 95% CI, 0.63-1.51; = .95).

CONCLUSIONS

Coronary atherectomy for ACS is infrequently performed in Japan. PCI volume and on-site surgical backup were not significantly associated with in-hospital mortality after coronary atherectomy for ACS.