Aims

Severe coronary calcification is still a challenge for percutaneous coronary intervention. Rotablation has been the only reliable option to treat extremely calcified coronary lesions. Contemporary data of patients undergoing rotablation are limited. This study aimed to analyse prevalence, trends, and outcomes in patients undergoing rotablation in Germany.

Methods

We analysed data on patient characteristics, treatments and in-hospital outcomes for all coronary artery disease (CAD) patients (ICD-code I25) with concomitant presence of procedural code of rotablation (OPS code: 8-837.5) in Germany 2005-2019 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2019, and own calculations).

Results

We analyzed data of 4,998,457 inpatients aged ≥18 years with diagnoses of coronary artery disease (CAD) in Germany; among these; among these, 28,587 (0.6%) underwent rotablation. The majority of patients were male (75.2%), had a median age of 75 years and a median hospital stay of 5 days. The annual number of rotablation increased substantially from 522 in 2005 to 5,116 in 2019 (β 1.91 [95% CI 1.86 to 1.96]; p<0.001) (Figure 1a). The proportion of rotablation in relation to the total numbers of patients with CAD increased until the 7^th decade (β 0.55 [95% CI 0.52 to 0.57]; p<0.001) (Figure 1b). Considering time periods, the case-fatality rate did not increase significantly between 2005-2009 and 2015-2019 (2.8% vs 3.1%; p=0.136), despite patients demonstrating a higher prevalence of heart failure (27.2% vs. 40.5%; p<0.001), atrial fibrillation/flutter (18.8% vs 27.0%; p<0.001), chronic renal insufficiency (24.9% vs. 33.1%) and other comorbidities compared to previous years.  In a multivariate logistic regression analysis (adjusted for age, sex and comorbidities), patients underwent rotablation between 2015 and 2019 did not have a lower risk of case-fatality compared to patients treated between 2005 and 2009 (OR 0.98 [95% CI 0.89-1.01]; p=0.816), but a lower risk of periprocedural complications such as transfusion of erythrocyte concentrates (OR 0.90 [95% CI 0.85-0.96]; p=0.001), haemopericardium (OR 0.85 [95% CI 0.72-0.99]; p=0.049), shock  (OR 0.60 [95% CI 0.54-0.66]; p<0.001) or cardiopulmonary resuscitation (OR 0.53 [95% CI 0.48-0.58]; p<0.001).

Conclusion

The use of rotablation increased substantially from 2005 to 2018 without a relevant change of in-hospital mortality rate in this real-world setting, despite patients’ characteristics shifted towards older age and higher prevalence of comorbidities.