Outcomes of Intravascular Imaging in Orbital Atherectomy; Insight From the National Readmissions Database

The impact of intravascular imaging guid-ance [intravascular ultrasound (IVUS)/optical coher-ence tomography (OCT)] on clinical outcomes in patients undergoing orbital atherectomy (OA) and percutaneous intervention (PCI) are not well charac-terized. The Nationwide Readmissions Database (NRD) from 2015 to 2019 was used to select all cases of OA. The adjusted odds ratios (aOR) of in-hospital, 30 -day, and 180-day hospitalization outcomes between patients who underwent PCI with OA vs without intra-vascular imaging were calculated using a propensity -matched analysis. A total of 15,681 patients undergo-ing PCI after OA (12,649 with no-imaging, 3032 with imaging) were identified. Due to a significant differ-ence in the baseline characteristics, a matched sample of 3008 in the no-imaging group and 3032 in the imag-ing group was selected. On adjusted analysis, the odds of all-cause in-hospital mortality (aOR 0.68, 95% CI 0.54-0.86) were significantly lower in patients undergo-ing IVUS/OCT guided OA and PCI compared with those having PCI without imaging. There was no dif-ference in the rate of in-hospital stroke (aOR 0.86, 95% CI 0.51-1.45) and major bleeding (aOR 0.87, 95% CI 0.65-1.16) between the two groups. There was no significant difference in the 30-and 180-day odds of readmission, major bleeding, coronary dissection, pericardial effusion, and AKI between the two groups. IVUS and OCT use during PCI with OA for patients with calcified coronary artery disease appear to be associated with reduced in-hospital mortality at index admission. Prospective trials are necessary to deter-mine the long-term benefits of imaging with PCI. (Curr Probl Cardiol 2023;48:101475.)