Outcomes of atherectomy in patients undergoing lower extremity revascularisation

DOI: 10.4244/EIJ-D-23-00432

Mazen Albaghdadi
Mazen Albaghdadi1, MD, MSc; Michael N. Young2, MD; Rasha Al-Bawardy3,4, MD; Peter Monteleone5,6, MD; Beau Hawkins7, MD; Ehrin Armstrong8, MD; Mohamad Kassab9, MD; Haitham Khraishah10, MD; Mohammed Chowdhury11, ChB, MSc, MB, MRes; Avnish Tripathi12, MD, MPH, PhD; Kevin K. Kennedy13, BS; Eric A. Secemsky14, MD, MSc
1. NCH Rooney Heart Institute, NCH Healthcare, Naples, FL, USA; 2. Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA; 3. National Guard Health Affairs, King Saud bin Abdulaziz University, Riyadh, Saudi Arabia; 4. King Abdullah International Medical Research Center (KAIMARC), Jeddah, Saudi Arabia; 5. Dell Medical School, The University of Texas at Austin, Austin, TX, USA; 6. Ascension Texas Cardiovascular, Austin, TX, USA; 7. Oklahoma Heart Hospital, Oklahoma City, OK, USA; 8. Adventist Heart Institute, Adventist Health St. Helena, St. Helena, CA, USA; 9. Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA; 10. Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; 11. Division of Vascular Surgery, Department of Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom; 12. CHI St. Vincent Heart Institute, Little Rock, AR, USA; 13. Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA; 14. Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA and Harvard Medical School, Boston, MA, USA and Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

Background: There is a paucity of real-world data on the in-hospital (IH) and post-discharge outcomes in patients undergoing lower extremity peripheral vascular intervention (PVI) with adjunctive atherectomy.

Aims: In this retrospective, registry-based study, we evaluated IH and post-discharge outcomes among patients undergoing PVI, treated with or without atherectomy, in the National Cardiovascular Data Registry PVI Registry.

Methods: The IH composite endpoint included procedural complications, bleeding or thrombosis. The primary out-of-hospital endpoint was major amputation at 1 year. Secondary endpoints included repeat endovascular or surgical revascularisation and death. Multivariable regression was used to identify predictors of atherectomy use and its association with clinical endpoints.

Results: A total of 30,847 patients underwent PVI from 2014 to 2019, including 10,971 (35.6%) treated with atherectomy. The unadjusted rate of the IH endpoint occurred in 524 (4.8%) of the procedures involving atherectomy and 1,041 (5.3%) of non-atherectomy procedures (p=0.07). After adjustment, the use of atherectomy was not associated with an increased risk of the combined IH endpoint (p=0.68). In the 6,889 (22.4%) patients with out-of-hospital data, atherectomy was associated with a reduced risk of amputation (adjusted hazard ratio [aHR] 0.67; 95% confidence interval [CI]: 0.51-0.85; p<0.01) and surgical revascularisation (aHR 0.63; 95% CI: 0.44-0.89; p=0.017), no difference in death rates (p=0.10), but an increased risk of endovascular revascularisation (aHR 1.21; 95% CI: 1.06-1.39; p<0.01) at 1 year.

Conclusions: The use of atherectomy during PVI is common and is not associated with an increase in IH adverse events. Longitudinally, patients treated with atherectomy undergo repeat endovascular reintervention more frequently but experience a reduced risk of amputation and surgical revascularisation.

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