Comparative Clinical Outcomes of Elective Coronary Atherectomy in Hospitals With Versus Without On-Site Surgical Backup: A Contemporary Nationwide Analysis.

The safety of complex percutaneous coronary intervention (PCI) at hospitals without on-site cardiac surgical backup (Non-SOS) has been broadly established, but data specifically addressing elective coronary atherectomy in this setting remain limited. To evaluate whether on-site cardiac surgical backup status influences clinical outcomes of elective coronary atherectomy procedures using contemporary nationwide data. A retrospective cohort study was conducted using the National Inpatient Sample (NIS) from 2016 to 2023. Elective hospitalizations involving coronary atherectomy were identified using ICD-10-PCS codes. Facilities were stratified by on site coronary artery bypass grafting capability. The primary outcome was in hospital mortality. Inverse probability treatment weighting was utilized to adjust for baseline differences. A separate adjusted analysis evaluated annual hospital atherectomy volume and mortality using Firth's penalized logistic regression. We identified 21,595 weighted elective coronary atherectomy procedures (93.4% at SOS hospitals). After Inverse probability treatment weighting adjustment, in-hospital mortality, although numerically higher, did not differ significantly between SOS and Non-SOS centers (OR 0.503; 95% CI 0.203 to 1.249; p = 0.139). Emergency coronary artery bypass grafting was performed in 1.4% of SOS patients, with a 14.0% mortality rate. Emergent transfer rates were higher at Non SOS hospitals (1.8% vs 0.6%; p = 0.026). Annual hospital atherectomy volume ≥30 procedures was independently associated with lower mortality (Firth-adjusted OR 0.06; 95% CI 0.01 to 0.21; p <0.001). Elective coronary atherectomy was performed with comparable in hospital mortality regardless of on-site surgical backup status. Hospital atherectomy volume was the strongest institutional predictor of mortality.