Comparison of the incidence of periprocedural myocardial infarction between percutaneous coronary intervention with versus without rotational atherectomy using propensity score-matching

Yusuke Mizuno,Hiroshi Wada,Kei Yamamoto,Takunori Tsukui,Kenichi Sakakura,Hiroyuki Jinnouchi,Hideo Fujita,Masaru Seguchi,Yousuke Taniguchi

doi:10.1038/s41598-021-90042-8

Abstract

Complications such as slow flow are frequently observed in percutaneous coronary intervention (PCI) with rotational atherectomy (RA). However, it remains unclear whether the high incidence of slow flow results in the high incidence of periprocedural myocardial infarction (PMI), reflecting real myocardial damage. The aim of this study was to compare the incidence of PMI between PCI with versus without RA using propensity score-matching. We included 1350 elective PCI cases, which were divided into the RA group (n = 203) and the non-RA group (n = 1147). After propensity score matching, the matched RA group (n = 190) and the matched non-RA group (n = 190) were generated. The primary interest was to compare the incidence of PMI between the matched RA and non-RA groups. Before propensity score matching, the incidence of slow flow and PMI was greater in the RA group than in the non-RA group. After matching, the incidence of slow flow was still greater in the matched RA group than in the matched non-RA group (16.8% vs. 9.5%, p = 0.048). However, the incidence of PMI was similar between the matched RA and matched non-RA group (7.4% vs. 5.3%, p = 0.528, standardized difference: 0.086). In conclusion, although use of RA was associated with greater risk of slow flow, use of RA was not associated with PMI after a propensity score-matched analysis. The fact that RA did not increase the risk of myocardial damage in complex lesions would have an impact on revascularization strategy for severely calcified coronary lesions.

Highlights

Complications such as slow flow are frequently observed in percutaneous coronary intervention (PCI) with rotational atherectomy (RA)
It is of importance to confirm whether RA increases the incidence of periprocedural myocardial infarction (PMI), because interventional cardiologists would hesitate to select RA among several specific procedures including orbital atherectomy and intravascular lithotripsy for severely calcified lesions if RA increases the incidence of PMI considerably
1377 elective PCI cases were performed in our hospital from January 2018 to March 2020, and 27 PCI cases were excluded

Summary

Introduction

Complications such as slow flow are frequently observed in percutaneous coronary intervention (PCI) with rotational atherectomy (RA) It remains unclear whether the high incidence of slow flow results in the high incidence of periprocedural myocardial infarction (PMI), reflecting real myocardial damage. Even randomized studies may not answer clearly whether the incidence of PMI was greater in PCI with RA, because the prevalence of crossover from PCI without RA to PCI with RA was quite high (12.5–16.0%) in recent randomized trials comparing PCI with versus without R A15,16, which is much higher rates of crossover compared to other randomized studies in the field of P CI17,18 Considering these specific background regarding PCI with RA, we hypothesized that a propensity score-matched analysis would work for adjusting clinical and lesion characteristics between PCI with versus without RA. The aim of this study was to compare the incidence of PMI between PCI with versus without RA using a propensity score-matched analysis

Objectives

Methods

Results

Conclusion