BACKGROUND Adjunctive coronary atherectomy (CA) can be utilized in treating severely calcified coronary lesions; however, the temporal trends, patient selection, and variation in use of CA have not been well described. We sought to assess the trends in usage, interhospital variability, and outcomes with CA among patients undergoing percutaneous coronary intervention (PCI). METHODS All patients undergoing PCI in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009 to December 31, 2016 (N=3 864 377) were analyzed based on utilization of either rotational or orbital CA. Intervals using date of index CA grouped into 2009 Q3 to 2010, 2011 to 2012, 2013 to 2014, and 2015 to 2016 and hospital-level quartiles based on annual CA volumes were evaluated. The primary outcome measure was in-hospital major adverse cardiac events defined as a composite of all-cause mortality, periprocedural myocardial infarction, or stroke. Independent variables associated with outcomes were determined. RESULTS CA represented 1.7% (n=65 033) of the total PCI volume. Among hospitals performing PCI (n=1672), 577 (34.5%) did not perform any CA. Patients treated with CA were elderly, more often male, and had a history of diabetes, prior myocardial infarction, PCI, and coronary artery bypass grafting. The utilization of CA increased from 1.1% in Q3 2009 to 3.0% in Q4 of 2016 (5% quarterly increase in odds of CA; OR [95% CI], 1.05 [1.04-1.06], P<0.001). Among patients undergoing CA, there was a temporal decline in major adverse cardiac events (0.98 [0.97-0.99], P<0.001) and myocardial infarction (0.97 [0.96-0.98], P<0.001). In adjusted analyses, increasing hospital CA volume was associated with lower mortality (0.85 [0.76-0.96], P=0.01) and lower rates of PCI failure or complication requiring coronary artery bypass grafting (0.67 [0.56-0.79], P<0.001) but was associated with small increase in coronary perforation (1.18 [1.04-1.35], P<0.01). CONCLUSIONS Although CA is performed infrequently, its use has increased over time. After accounting for potential confounders, higher CA volume was associated with lower risk of major adverse events counterbalanced by small risk of coronary perforation.

中文翻译：

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冠状动脉粥样硬化切除术的使用趋势和临床结果：国家心血管数据注册系统CathPCI注册系统的报告。

背景技术辅助冠状动脉粥样硬化斑块切除术（CA）可用于治疗严重钙化性冠状动脉病变。然而，关于CA的时间趋势，患者选择和使用变化还没有很好地描述。我们试图评估经皮冠状动脉介入治疗（PCI）患者的使用趋势，院际差异和CA结局。方法根据旋转或轨道CA的使用情况，对2009年7月1日至2016年12月31日在美国国家心血管数据注册中心CathPCI注册中心接受PCI治疗的所有患者（N = 3 864 377）进行分析。根据年度CA量评估了使用索引CA的时间间隔（分为2009年第三季度至2010年，2011年至2012年，2013年至2014年以及2015年至2016年）以及医院级四分位数。主要结局指标是院内主要不良心脏事件，定义为全因死亡率，术中心肌梗塞或中风的综合。确定与结果相关的自变量。结果CA占PCI总量的1.7％（n = 65033）。在进行PCI的医院中（n = 1672），有577家医院（34.5％）未进行任何CA。接受CA治疗的患者为老年患者，多为男性，并且有糖尿病史，先前有心肌梗塞，PCI和冠状动脉搭桥术。CA的利用率从2009年第三季度的1.1％增加到2016年第四季度的3.0％（CA几率每季度增加5％；或[95％CI]，1.05 [1.04-1.06]，P <0.001）。在接受CA的患者中，主要不良心脏事件（0.98 [0.97-0.99]，P <0.001）和心肌梗塞（0.97 [0.96-0.98]）在时间上有所减少，P ＜0.001）。在调整后的分析中，医院CA容量增加与死亡率降低（0.85 [0.76-0.96]，P = 0.01）和PCI失败或需要冠状动脉搭桥术的并发症发生率降低（0.67 [0.56-0.79]，P <0.001）相关。但与冠状动脉穿孔的少量增加相关（1.18 [1.04-1.35]，P <0.01）。结论尽管CA不经常执行，但随着时间的推移，CA的使用有所增加。在考虑了潜在的混杂因素之后，较高的CA量与较低的主要不良事件风险（较小的冠状动脉穿孔风险抵消）相关。001），但与冠状动脉穿孔的小幅增加相关（1.18 [1.04-1.35]，P <0.01）。结论尽管CA不经常执行，但随着时间的推移，CA的使用有所增加。在考虑了潜在的混杂因素后，较高的CA量与较低的主要不良事件风险（较小的冠状动脉穿孔风险抵消）相关。001），但与冠状动脉穿孔的小幅增加相关（1.18 [1.04-1.35]，P <0.01）。结论尽管CA不经常执行，但随着时间的推移，CA的使用有所增加。在考虑了潜在的混杂因素后，较高的CA量与较低的主要不良事件风险（较小的冠状动脉穿孔风险抵消）相关。