In-hospital Outcomes of Rotational Atherectomy in Relation to Operator Volumes: Data from an Asian National Databank

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Background: Rotational atherectomy (Rota-percutaneous coronary intervention [PCI]), a technique for severely calcified complex coronary lesions, is technically challenging and associated with procedural risk. We used a national cardiac registry to study the relationship between operator Rota-PCI volumes and patient selection, procedural success and in-hospital patient outcomes. Methods: We conducted a retrospective analysis of Rota-PCI procedures from the Singapore Cardiac Databank (2013–2019), stratifying operators into tertiles by annualised procedure volume. Logistic regression analyses were used to evaluate the association between operator volume and in-hospital outcomes. Results: In all, 1,278 Rota-PCI procedures were performed by 37 operators during the study period. Higher-volume operators treated patients with greater comorbidity burdens and more complex coronary anatomy. On univariate analysis, higher annual Rota-PCI volume per operator was significantly associated with greater in-hospital mortality (OR 1.04/case; 95% CI [1.01–1.08]; p=0.006) and greater in-hospital major adverse cardiac and cerebral events (OR 1.03/case; 95% CI [1.00–1.05]; p=0.026). However, when adjusted for key clinical confounders, including renal disease, acute coronary syndrome presentation, left ventricular ejection fraction <30%, left main stem disease and mechanical circulatory support, the association between annual operator Rota-PCI volumes and in-hospital mortality was no longer significant (OR 1.02/case; 95% CI [0.99–1.05]; p=0.20). Across all models, no significant associations were observed between operator volume and other in-hospital adverse events. Conclusion: Operator annualised Rota-PCI volume was not independently associated with in-hospital adverse outcomes. Procedural risk appears primarily determined by patient and lesion complexity, institutional support and operator expertise rather than procedural volume alone.

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