Abstract 4139467: Application and Outcomes of Coronary Atherectomy in Patients with Acute Coronary Syndrome: A Report from the Nationwide J-PCI Registry

Introduction: Acute coronary syndrome (ACS) has been generally considered a relative contraindication to coronary atherectomy. Aims: The objective of this study was to investigate the temporal trends and hospital variability in the use of coronary atherectomy and its outcomes among patients undergoing percutaneous coronary intervention (PCI) for ACS from a nationwide PCI registry in Japan. Methods: First, we analyzed the temporal trend in the use of rotational atherectomy (RA) and orbital atherectomy (OA) during PCI for ACS patients between 2014 and 2022 (822,237 PCIs from 1,269 hospitals). Next, we assessed the outcomes of the patients who underwent RA for ACS between 2019 and 2022 (7,421 patients across 662 hospitals). The primary outcome was in-hospital mortality after PCI. Patient outcomes associated with hospital PCI volumes and the device policy change on coronary atherectomy in Japan in 2020, which allowed operators to perform coronary atherectomy without on-site surgical backup, were also evaluated. Results: The rate of RA for ACS was low at 2.0% in the overall cohort (16,264/822,237 PCIs); the rate slightly increased from 1.9% in 2014-2019 to 2.1% in 2020-2022 (after the device policy change). The rate of PCI with OA for ACS was also low at 0.8% in 2021-2022 (1,404/185,141 PCIs). Increasing the complexity of baseline characteristics, including advanced age, diabetes, chronic kidney disease, dialysis, peripheral arterial disease, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, cardiac arrest within 24 h, cardiogenic shock within 24 h, three-vessel disease, and mechanical circulatory support during PCI was significantly associated with increased in-hospital mortality after PCI with RA in ACS patients (P<0.05 for all). Annual hospital PCI volumes (odds ratio, 0.937; 95% CI, 0.653-1.361; P=0.729 for high- vs. low-volume hospitals) and newcomer facilities starting RA after the device policy change (odds ratio, 0.987; 95% CI, 0.651-1.361; P=0.951) were not significantly associated with in-hospital outcomes after RA for ACS. Conclusions: The present study using a nationwide multicenter PCI registry showed that the overall rate of PCI with coronary atherectomy for ACS was low but slightly increased after the device policy change in Japan. Hospital PCI volumes and newly accredited facilities on coronary atherectomy after the device policy change were not associated with in-hospital outcomes after RA for ACS.