Predictors of in-hospital effectiveness and complications of rotational atherectomy (from the ORPKI Polish National Registry 2014-2016).

OBJECTIVE: The aim of the study was to assess trends in the use and periprocedural outcomes of rotational atherectomy (RA) in Poland between January 2014 and December 2016.
BACKGROUND: In recent years, due to the aging population, RA is becoming more commonly used to treat heavily calcified coronary artery stenoses.
METHODS: Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry on all percutaneous coronary intervention (PCI) procedures performed in Poland. In total, 1,175 RA procedures were recorded from 317,175 PCI procedures (incidence of 0.37%).
RESULTS: Patients undergoing RA were older (71.7 ± 9.7 vs. 66.9 ± 10.8, P < 0.00001) and less often males (68.3% vs. 76.4%, P < 0.00001). The complication rate was significantly higher in the RA group (P = 0.0012) with the leading coronary artery perforation (CAP) (P < 0.0001). Complication frequency decreased significantly in the last 3 years and was accompanied by an increase in the percentage of radial access and patients with stable angina. Among several predictors of the use of RA during PCI in multivariate analysis, the strongest one was previous coronary artery by-pass grafting (P < 0.0001), whereas the strongest, predictor of CAP was the RA procedure (P = 0.00004). The increase in RA frequency over the last 3 years may reflect population aging, some fluctuations in indications for RA and reimbursement policies.
CONCLUSIONS: We observed a substantial increase in the utilization of RA during PCIs performed in Poland; however, it still needs to be increased. Decreased frequency of RA procedures follows change in indications for RA and vascular access. Periprocedural complication rates significantly decreased over the last 3 years.