Comparative Outcomes of RA and MB in Cardiovascular Procedures

Sep 16, 2024

Photo Credit: Vectors

The following is a summary of “Procedural safety of rotational atherectomy and modified balloon angioplasty: insights from a German national registry,” published in the September 2024 issue of Cardiology by Maier et al.

Researchers conducted a retrospective study to evaluate the safety of Modified balloons (MB) and rotational atherectomy (RA) in treating coronary artery lesions with superficial calcium.

They identified patients with coronary artery disease who had coronary angiography with RA or MB angioplasty in Germany through ICD and OPS codes from 2017 to 2020. Acute coronary syndromes were excluded, and there was no randomization between MB and RA; potential confounding factors were controlled using propensity score methods, including inverse probability weighting.

The results showed that 10,092 patients underwent RA, increasing from 1,817 in 2017 to 3,166 in 2020; MBs were used in 22,378 patients, rising from 4,771 in 2017 to 6,078 in 2020. Patients receiving RA were older (74.23 ± 8.68 years vs. 71.86 ± 10.02 years, P<0.001), had a higher Charlson Comorbidity Index (2.07 ± 1.75 vs. 1.99 ± 1.76, P=0.001), and more often had left main disease (17.96% vs. 12.91%, P<0.001) or 3-vessel disease (66.25% vs. 58.10%, P<0.001). The adjusted procedural risk of major adverse cardiac and cerebrovascular events (MACCE) was similar in both groups, but RA was associated with more frequent pericardial effusion (RR 2.69; 95% CI 1.88–3.86, P<0.001), pericardial puncture/pericardiotomy/pericardial tamponade (RR 2.66; 95% CI 1.85–3.81, P<0.001), and bleeding (RR 1.65; 95% CI 1.12–2.43, P<0.011). Patients treated with RA at high-volume centers had shorter hospitalizations (P=0.005) and a lower rate of acute cerebrovascular events (P<0.001). The annual RA volume per center unaffected the MACCE, bleeding, and pericardial puncture rates.