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Introduction: Our objective was to describe the contemporary outcomes of orbital atherectomy (OA) vs. rotational atherectomy (RA) use for inpatient percutaneous coronary intervention (PCI) in the United States. Data on the use of OA vs. RA in contemporary inpatient PCI are limited. Methods: We queried the Nationwide Readmission Database (NRD) from January to November for the years 2016–2017 to identify hospitalizations of patients who underwent PCI with atherectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality. Results: We included 77,040 records of patients who underwent inpatient PCI with atherectomy. Of those, 71,610 (93%) had RA, and 5430 (7%) had OA. There was no significant change in the trend of using OA or RA over 2016 and 2017. OA was less utilized in patients presenting with ST-segment elevation myocardial infarction (STEMI) (4.3% vs. 46.8%, p< 0.001). In our cohort, OA was associated with lower in-hospital mortality (3.1% vs. 5%, p< 0.001) and 30-day urgent readmission (< 0.01% vs. 0.2%, p= 0.009), but a higher risk of coronary perforation (1.7% vs. 0.6%, p< 0.001) and cardiac tamponade (1% vs. 0.3%, p< 0.001) and a higher cost of index hospitalization ($28,199 vs. $23,188, p< 0.001) compared with RA. Conclusion: RA remains the predominant atherectomy modality for inpatient PCI in the United States (93%). There was no change in the trend of use for either modality over the years 2016 and 2017. OA was noted to have a lower incidence of in-hospital death, but a higher risk of coronary perforation and a higher cost of index hospitalization for the overall unmatched cohorts.

ABSTRACTBackground:Secondary mitral regurgitation (MR) arises from left ventricular (LV) dilatation and remodeling, and commonly is treated with transcatheter mitral valve repair. We examined the impact of MitraClip on reverse cardiac remodeling in patients with severe, symptomatic secondary MR.Methods:: An electronic search was performed through January 2018 for studies that reported cardiac chamber dimensions prior to and after treatment with MitraClip in patients with secondary MR. The mean difference (MD) with 95% CI was calculated using fixed or random inverse variance models. Outcomes of interest were changes in LV end-systolic and end-diastolic volumes (LVESV, LVEDV) and dimensions (LVESD, LVEDD). Secondary outcomes included left atrial (LA) volume, systolic pulmonary artery pressure (sPAP) and LV ejection fraction (LVEF).Results:A total of 16 studies with 1,266 patients were included in the present analysis. The weighted mean follow-up period (±SD) was 11.5 ± 7.2 months. MitraClip was associated with significant reduction in LVEDV (−14.24 ml, 95% CI [−22.53, −5.94], p = 0.0008), LVESV (−7.67 ml, CI [−12.30, −3.03], p = 0.001), LVEDD (−2.92 mm [−3.65, −2.19 mm], p < 0.00001), and LVESD (−1.92 mm [−2.92, −0.92], p = 0.0002). MitraClip was also associated with reduction in LA volume (−16.36 ml [23.23, −9.49 ml], p < 0.00001) and sPAP (−6.93 mmHg [−8.76, −5.10], p < 0.00001), and a significant increase in LVEF (+ 2.78% [0.91, 4.66], p = 0.004).Conclusions:In patients with severe symptomatic secondary MR, MitraClip is associated with modest, but favorable LV and LA reverse remodeling. The impact of these changes on clinical outcomes deserves further study.

ABSTRACTBackground:Atrial fibrillation (AF) has been associated with worse outcomes in patients undergoing mitral valve surgery for mitral regurgitation. The impact of preexisting AF on the outcomes after transcatheter mitral valve repair with MitraClip® (Abbott Vascular, Santa Clara, CA, USA) has not been well studied.Methods:An electronic search was performed until December 2017 for studies reporting outcomes after MitraClip® in patients with AF versus those with no AF. Outcomes of interest included all-cause mortality, stroke and major adverse cardiovascular events (MACE) defined as the composite outcome of death, stroke, and myocardial infarction at the longest follow-up reported.Results:A total of four studies including 1473 patients (AF n = 697; no AF n = 776) were included. There was no difference in procedural success or procedural time between patients with AF versus those without AF. AF was associated with increased mortality after MitraClip® compared with patients with no AF (OR 1.54, 95% CI (1.16, 2.04), p = 0.003, I2 = 0%) over a mean follow-up period of 10.2 months. In a sensitivity analysis excluding early postoperative (30-day) outcomes, AF remained associated with higher mortality (OR 1.53, 95% CI (1.15, 2.03), p = 0.003, I2 = 19%). AF was associated with a higher incidence of MACE after MitraClip® (OR 1.46, 95% CI (1.03, 2.07), p = 0.03, I2 = 13%). No difference was observed in the risk of stroke between patients with versus without AF after MitraClip® (OR 1.13, 95%CI (0.36, 3.56), p = 0.84, I2 = 37%).Conclusions:Compared with patients without AF, patients with preexisting AF are at higher risk of death and MACE after MitraClip®.