Impact of End‐Stage Renal Disease on Outcomes of Rotational Atherectomy‐Assisted Percutaneous Coronary Interventions: Insights From a National Inpatient Cohort

BACKGROUND: Rotational atherectomy (RA) has become one of the most popular percutaneous coronary intervention (PCI) modalities for the management of patients with calcified coronary artery disease. However, the impact of end-stage renal disease (ESRD) on the post-RA outcomes is not fully determined. METHODS: We implemented the National Inpatient Sample (NIS) data of a propensity-score matched sample of adult cases who underwent RA from 2016 to 2021 to retrospectively compare their in-hospital outcomes according to the ESRD status. Multivariable regression models explored their complications. RESULTS: A 1:1 matched cohort of 11,555 with underlying ESRD and 11,555 without undergoing RA was generated. In terms of post-RA outcomes and complications, multivariate regression revealed increased adjusted odds ratios (aOR) for death (aOR: 1.514; 95% CI: 1.308-1.752; p < 0.001), major bleeding (aOR: 3.845; 95% CI: 3.595-4.113; p < 0.001), postoperative sepsis (aOR: 1.819; 95% CI: 1.517-2.183; p < 0.001), cardiac arrest (aOR: 1.169; 95% CI: 1.015-1.347; p = 0.03), cardiogenic shock (aOR: 1.212; 95% CI: 1.084-1.354; p < 0.001), and vasopressor use (aOR: 1.511; 95% CI: 1.249-1.828; p < 0.001) in the ESRD cohort. CONCLUSION: The in-hospital morbimortality after RA differs significantly in patients with and without ESRD. Notably, this comorbidity is independently associated with poorer outcomes and complications post RA. Therefore, the ESRD status should be considered for preoperative stratification of patients undergoing RA-guided PCI.