Contemporary use and outcomes associated with rotational versus orbital atherectomy in percutaneous coronary interventions: Insights from the blue cross blue shield of michigan cardiovascular consortium

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BACKGROUND Atherectomy devices have been used with the goal of improving outcomes during percutaneous coronary intervention (PCI) of heavily calcified lesions. There is a paucity of contemporarydata evaluating the safety and efficacy of orbitalatherectomy versus rotational atherectomy in real world practice. METHODS We evaluated theoutcomes of 1,641 patients who underwent PCI using either rotational atherectomy (RA) or orbitalatherectomy (OA) from 2014-2016 at 33 hospitals inMichigan participating in the Blue Cross Blue Shieldof Michigan Cardiovascular Consortium. RESULTS Therate of use of both strategies has increased since 2014, although over-all use remains low (1.6% RA vs. 1.1% OA). There was a higher rate of perforation withRA than with OA (1.8% vs. 0.4%, p=0.021), a higher rate of significant dissection (1.7% vs. 0.6%, p=0.065), and more bleeding events within 72 hours (7.4% vs. 4.2%, p=0.014). There was no significant difference inthe rate of CABG (0.4% vs. 0.4%, p=0.856), death (2.6% vs. 1.9%, p=0.407), or myocardial infarction (5.5% vs. 4.8%, p=0.587) between RA versus OA, respectively. CONCLUSION Use of atherectomy during PCI remains low, but is steadily increasing. Orbital atherectomy as opposed to rotational atherectomy was associatedwith a slightly lower rate of complications including dissection, perforation, and bleeding but with no difference in death, MI, or CABG. Further study is needed to determine whether the observed difference in procedural outcomes is device or lesion related.





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