Comparative Safety and Effectiveness of Orbital and Rotational Atherectomy in Patients Undergoing Percutaneous Coronary Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

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Conference Proceeding

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J Am Coll Cardiol


Background: Severe coronary artery calcification in patients undergoing percutaneous coronary intervention (PCI) increases the procedural complexity, limits procedural success, and is associated with a greater likelihood of complications. However, there is a paucity of data comparing rotational atherectomy (RA) and orbital atherectomy (OA), the primary modalities for treating moderate-severe coronary artery calcification. Methods: In this retrospective cohort study, we analyzed data from 48 hospitals participating in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium), a prospective multicenter registry of all PCIs performed at nonfederal hospitals in Michigan. We used optimal full matching to account for the nonrandom use of RA or OA. Results: Of the 135,243 consecutive PCIs performed between January 2014 and March 2018, an atherectomy device was used in 2,994 (2.21%) cases (RA = 1,801, OA = 1,033). In the fully adjusted optimally matched analysis, both OA (n = 1,026) and RA (n = 1,786) had similar rates of procedural success (defined as residual stenosis ≤30%) adjusted odds ratio (aOR): 0.85 (95% confidence interval [CI]: 0.59 to 1.25; p = 0.430) and perfect procedural success (defined as residual stenosis ≤10%) aOR: 1.14 (95% CI: 0.87 to 1.47; p = 0.357). Compared with RA, OA was associated with a lower risk of significant dissection (aOR: 0.44; 95% CI: 0.21 to 0.92; p = 0.029). However, the rates of perforation, bleeding, stent thrombosis, persistent no-reflow, emergency or salvage CABG, and all-cause death were similar (Figure). [Figure presented] Conclusion: RA and OA have comparable safety and effectiveness in facilitating PCI in heavily calcified coronary lesions. Categories: CORONARY: Atherectomy (excluding thrombectomy)





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