1Universitäts-Herzzentrum Freiburg - Bad Krozingen Klinik für Kardiologie und Angiologie Freiburg im Breisgau, Deutschland; 2Institut für Medizinische Biometrie und Statistik Universitätsklinikum Freiburg Freiburg, Deutschland; 3Universitäts-Herzzentrum Freiburg - Bad Krozingen Innere Medizin III, Kardiologie und Angiologie Freiburg im Breisgau, Deutschland; 4Albert- Ludwigs-Universität Freiburg Innere Medizin III, Kardiologie und Angiologie Freiburg im Breisgau, Deutschland
Background: Clinical management and lesion preparation of heavily calcified coronary stenoses is challenging. Cutting or scoring balloons and rotational atherectomy are interventional tools for coronary calcified lesion treatment and both are recommended for plaques with superficial calcium. Knowledge about patient characteristics receiving these procedures, recent in-hospital safety and safety comparison of both procedures is limited.
Methods: Patients with coronary artery disease who underwent coronary angiography with rotational atherectomy or cutting/scoring balloon procedure in Germany were identified via ICD and OPS codes from 2017 - 2020. Patients with acute coronary syndromes such as NSTEMI, STEMI or unstable angina were excluded from the dataset.
Results: From 2017 – 2020 10,092 patients underwent rotational atherectomy with an increasing trend from 1,817 in 2017 towards 3,166 in 2020. Cutting/scoring balloons were used in 22,378 patients also with an increasing trend from 4,771 in 2017 towards 6,078 in 2020.
Patients receiving rotational atherectomy were older (74.23 +/- 8.68 vs. 71.86 +/- 10.02, p < 0.001), had a higher Charlson Comorbidity Index (2.07 +/- 1.75 vs. 1.99 +/- 1.76, p = 0.001) and more frequently left main (17.96 % vs. 12.91 %, p < 0.001) or three vessel disease (66.25 % vs. 58.10 %, p < 0.001) as well as renal disease (25.88 % vs. 24.03 %, p < 0.001) and diabetes (37.39 % vs. 35.58 %, p = 0.002). They had more frequently atrial fibrillation (26.13 % vs. 23.63 %, p < 0.001) with a higher CHA2DS2-VASc score (4.29 +/- 1.27 vs. 4.08 vs. 1.36, p < 0.001). Congestive heart failure, previous stroke, COPD, pulmonary hypertension and cancer were distributed similarly in both groups.
Procedural risk of stroke (0.53 % vs. 0.46 %), other acute cerebrovascular events (4.97 % vs. 4.67 %) and ventilation > 48h (1.09 % vs. 1.05 %) was similar in both groups, while pericardial effusion (1.92 % vs. 0.93 %, p < 0.001), pericardial puncture/pericardiotomy/pericardial tamponade (1.03 % vs. 0.41 %, p < 0.001) and bleeding (0.79 % vs. 0.55 %, p < 0.001) occurred more frequently in patients receiving rotational atherectomy.
Conclusion: Both rotational atherectomy and scoring/cutting balloons are commonly used procedures for angioplasty in calcified lesions, while scoring/cutting balloons were used more frequently. Patient receiving rotational atherectomy were older, had more comorbidities and more severe coronary artery disease. Procedural safety regarding bleeding and need for pericardial puncture is superior for cutting/scoring balloons.