Procedural safety of rotational atherectomy and modified balloon angioplasty: insights from a German national registry

IF 3.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Research in Cardiology Pub Date : 2024-09-11 DOI:10.1007/s00392-024-02538-8

Alexander Maier, Mark Colin Gissler, Markus Jäckel, Vera Oettinger, Lucas Bacmeister, Adrian Heidenreich, Jonathan Rilinger, Lukas A. Heger, István Bojti, Christian Weber, Dennis Wolf, Ingo Hilgendorf, Faridun Rahimi, Miroslaw Ferenc, Dirk Westermann, Klaus Kaier, Constantin von zur Mühlen

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引用次数: 0

Abstract

Background

Modified balloons (MB) and rotational atherectomy (RA) are recommended tools for treatment of coronary plaques with superficial calcium. Knowledge about in-hospital safety is limited.

Methods

Patients with coronary artery disease who underwent coronary angiography with RA or MB angioplasty in Germany were identified via ICD and OPS codes from 2017 to 2020. Acute coronary syndromes were excluded. Since patients were not randomized toward MB or RA, potential confounding factors were taken into account using the propensity score methods. Thereby, inverse probability weighting was applied.

Results

Ten thousand.ninety-twopatients underwent RA with an increasing trend from 1817 in 2017 toward 3166 in 2020. MBs were used in 22,378 patients also with an increasing trend from 4771 in 2017 toward 6078 in 2020.

Patients receiving RA were older (74.23 ± 8.68 vs. 71.86 ± 10.02, p < 0.001), had a higher Charlson Comorbidity Index (2.07 ± 1.75 vs. 1.99 ± 1.76, p = 0.001) and more frequently left main (17.96% vs. 12.91%, p < 0.001) or three vessel disease (66.25% vs. 58.10%, p < 0.001). Adjusted procedural risk of major adverse cardiac and cerebrovascular events (MACCE) was similar in both groups, while pericardial effusion (RR 2.69; 95% CI 1.88–3.86, p < 0.001), pericardial puncture/pericardiotomy/pericardial tamponade (RR 2.66; 95% CI 1.85–3.81, p < 0.001) and bleeding (RR 1.65; 95% CI 1.12–2.43, p < 0.011) occurred more frequently in patients receiving RA. Patients treated with RA at high volume centers were hospitalized shorter (p = 0.005) and had a lower rate of acute cerebrovascular events (p < 0.001). Rate of MACCE, bleeding and pericardial puncture were not influenced by the annual RA numbers per center.

Conclusion

MBs had a lower risk of bleeding and pericardial puncture. Patients treated at centers with high annual RA procedure numbers had a lower risk of acute cerebrovascular events and were hospitalized shorter.

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旋转动脉粥样硬化切除术和改良球囊血管成形术的手术安全性：来自德国国家登记处的启示

背景改良球囊（MB）和旋转动脉粥样硬化切除术（RA）是治疗冠状动脉浅表钙化斑块的推荐工具。方法通过 ICD 和 OPS 编码识别了 2017 年至 2020 年在德国接受 RA 或 MB 血管成形术冠状动脉造影术的冠心病患者。急性冠状动脉综合征被排除在外。由于患者并非随机选择 MB 或 RA，因此使用倾向评分法考虑了潜在的混杂因素。结果1.92万名患者接受了RA治疗，从2017年的1817人增加到2020年的3166人。接受 RA 治疗的患者年龄较大（74.23 ± 8.68 vs. 71.86 ± 10.02，P < 0.001），Charlson合并症指数更高（2.07 ± 1.75 vs. 1.99 ± 1.76，p = 0.001），左主干（17.96% vs. 12.91%，p <0.001）或三血管疾病（66.25% vs. 58.10%，p <0.001）更频繁。两组主要不良心脑血管事件（MACCE）的调整后程序风险相似，而心包积液（RR 2.69; 95% CI 1.88-3.86, p < 0.001）、心包穿刺/心包切开/心包填塞（RR 2.66；95% CI 1.85-3.81，p <；0.001）和出血（RR 1.65；95% CI 1.12-2.43，p <；0.011）在接受RA治疗的患者中发生率更高。在高流量中心接受 RA 治疗的患者住院时间更短（p = 0.005），急性脑血管事件发生率更低（p < 0.001）。MACCE、出血和心包穿刺率不受每个中心年RA数量的影响。在年RA手术数量多的中心接受治疗的患者发生急性脑血管事件的风险较低，住院时间较短。

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来源期刊

Clinical Research in Cardiology 医学-心血管系统

CiteScore

11.40

自引率

4.00%

发文量

140

审稿时长

4-8 weeks

期刊介绍： Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.