PCI With Directional Coronary Atherectomy in Stable CAD or Unstable Angina

Percutaneous coronary intervention (PCI) with the revived directional coronary atherectomy (DCA) catheter is safe and has low complication rates in patients with stable coronary artery disease or unstable angina, according to a study published in Catheterization & Cardiovascular Interventions.

Researchers sought to assess differences in baseline characteristics of and in‐hospital outcomes for patients with stable coronary artery disease or unstable angina who underwent PCI with or without DCA based on data from a Japanese nationwide coronary intervention registry.

A total of 188,324 patients from 1112 Japanese hospitals were included from January to December 2018. The participants are categorized into 2 groups, the DCA group (n=1696; mean age, 68.0±11.2 years; 14.2% women) and the non-DCA group (n=186,628; mean age, 71.3±10.6 years; 23.3% women).

The DCA group patients are younger, more frequently men, and have a lower rate of comorbidities, including hypertension, diabetes mellitus, and chronic kidney disease, compared with patients in the non‐DCA group. Patients in the DCA group also are less likely to have unstable angina and have emergency PCI vs patients in the non‐DCA group.

Drug‐eluting stents (DES) are used less frequently among DCA group participants (45.9%) vs the non‐DCA group (82.5%), and drug‐coated balloons (DCB) are used more frequently in the DCA group (63.4%) vs the non-DCA group (20.0%). Stentless PCI is more common in the DCA group (53.7%) vs the non‐DCA group (17.3%). Within the DCA group, 50% of patients have stentless PCI using DCA with additional DCB angioplasty, followed by 32% who have DCA plus a stent.

The DCA group have a 99.8% procedural success rate vs 98.3% for the non-DCA group. Also, the DCA group have a 1.8% rate of overall complications and a 0.2% rate of in-hospital mortality, compared with a 1.7% rate of overall complications and 0.3% in-hospital mortality rate in the non-DCA group.

Fluoroscopy time (47.5±23.4 minutes) is longer and the total contrast volume (168.4±77.2 mL) is higher in the DCA group compared with the non‐DCA group (30.2±28.4 minutes and 126.1±67.4 mL, respectively).

Study limitations include the observational design and use of data from an ongoing, prospective, nationwide registry. In addition, long‐term follow‐up data are not available for clinical outcomes after PCI with or without DCA, and the definition of bleeding complications differed from the standard criteria. Furthermore, the registry did not include precise procedural data regarding the size of sheaths and catheters and other clinical factors of PCI using DCA.

“This Japanese nationwide registry‐based study showed that the novel DCA catheter is safely used in patients with stable coronary artery disease or unstable angina with low complication rates, even when comparing in‐hospital outcomes with those in the non‐DCA group undergoing PCI, mainly with new‐generation DES,” the investigators wrote.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Numasawa Y, Inohara T, Ishii H, et al. Overview of in‐hospital outcomes in patients undergoing percutaneous coronary intervention with the revived directional coronary atherectomy. Catheter Cardiovasc Interv. Published online May 20, 2022. doi: 10.1002/ccd.30233