In-hospital outcomes of rotational atherectomy in relation to operator volumes: data from an asian national databank

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Studies investigating the relationship between percutaneous coronary intervention operator volumes and patient adverse events largely, but not consistently, suggest an inverse association. A recent study of rotational atherectomy (Rota-PCI) suggests lower adverse events as operator volumes increased. Purpose In this study, we aimed to use a Southeast asian national registry to investigate the relationship of Rota-PCI operator volumes to patient selection, procedural success, and in-hospital outcomes. Methods Data from a national databank was analysed for all Rota-PCI procedures performed at public hospitals from 2013 to 2019. No procedures were excluded. Operator volumes were divided into 3 tertiles and logistic regressions were performed to investigate the association to patient selection, procedural success, and in-hospital clinical outcomes. Results A total of 1,278 Rota-PCI procedures, with 37 operators performing a median volume of 23 procedures per year was included. The tertiles had median volumes of 5, 17 and 30 annually respectively. Operators at the highest tertile performed Rota-PCI in more patients with renal disease (43% vs 49% vs 53%, Tertiles 1, 2, 3 respectively; p=0.006), ACS presentations (34% vs 37% vs 41%, p=0.036), severe left ventricular dysfunction (28% vs 42% vs 44%, p<0.001), and left main disease (17% vs 24% vs 31%, p<0.001). This group also attempted more lesions (2 vs 2 vs 3, p<0.001), and utilized more circulatory support (4.2% vs 7% vs 12%, p<0.001). Intracoronary imaging was used most by the lowest tertile (29% vs 24% vs 12%, p<0.001). Operators at the highest tertile had a higher incidence of complete heart block (2.1% vs 0.8% vs 3.9%, p=0.05) but had no difference in coronary complications. There was an increase in length of stay (2 vs 3 vs 3 days, p<0.001) but otherwise no difference in in-hospital outcomes of MI, major bleed, stroke and mortality in multivariate analysis. Conclusion In summary, in-hospital outcomes were similar between all three tertiles of operator volumes. These findings may reflect our local practice where operators appropriately triage Rota-PCI cases, with the most complex cases being assigned to high volume operators.