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)
Aggarwal D, Seth M, Perdoncin E, Schreiber T, Kaki A, Alaswad K, Menees D, Sukul D, and Gurm H. 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). J Am Coll Cardiol 2019; 74(13):B25.
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)