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Atherectomy plays a pivotal role in revascularization in patients with coronary artery calcification (CAC) undergoing percutaneous coronary intervention (PCI). There has been limited data on the clinical outcomes of atherectomy in female patients. No studies to date have compared orbital atherectomy (OA) and rotational atherectomy (RA) in females. We sought to examine the safety and efficacy of atherectomy in female patients with CAC.
This observational, prospective, multicenter study compared OA and RA in female patients with CAC who had atherectomy prior to PCI. 35,590 patients from 5 tertiary care hospitals who had PCI from January 2011 - April 2016 were identified. All female patients, who had RA or OA were included in our analysis (n=247).
107 patients were in the OA arm and 140 patients were included in the RA group (Table 1a). Procedural data is presented in Table 1b. The primary endpoint, death on discharge occurred in none of the OA patients as compared with 0.79% of the RA patients (p=0.254). There were no significant differences in secondary outcomes, including myocardial infarction or stroke, nor in individual procedural safety endpoints including dissection, perforation, tamponade, or major bleeding complications (Table 1c). Fluoroscopy time was significantly lower with OA compared with RA (21.31±9.77 vs. 27.59±16.52 min, p= 0.001).
In female patients with CAC who undergo atherectomy prior to PCI, OA was associated with significantly decreased fluoroscopy time compared with RA with no significant differences in safety endpoints and in-hospital outcomes. A reduction in radiation exposure has important ramifications for both patients and operators. This study demonstrates both the safety and efficacy of RA and OA in female patients; a subgroup severely underrepresented in atherectomy trials.