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Atherectomy is a treatment modality for lesion preparation in patients with coronary artery calcification (CAC) undergoing percutaneous coronary intervention (PCI). There have been no studies that have directly compared the outcomes of orbital atherectomy (OA) and rotational atherectomy (RA) in patients with severe left ventricular systolic dysfunction (LVSD). Given the lack of data, neither modality has been specifically approved for this complex higher-risk indicated patient (CHIP) subset. We sought to examine the safety of atherectomy prior to PCI in patients with CAC and LVSD.
This prospective, observational, multi-center study compared OA vs. RA in patients with CAC and LVSD. 35,590 patients were identified from 5 tertiary care hospitals whom had PCI from January 2011-April 2016. All patients, who had OA or RA with EF ≤ 35% were included in our analysis (n=164).
59 patients received OA and 105 patients received RA (Table 1a). Procedural data is presented in Table 1b. There were no significant differences in the primary endpoint, death on discharge, nor procedural safety endpoints (Table 1c). Compared with RA, OA had less post-PCI heart failure (1.69% vs. 9.52%, p=0.017), fluoroscopy time (22.1 vs. 27.7 mins., p= 0.012), and rate of bleeding requiring transfusion (6.77% vs. 16.19%, p=0.165).
Atherectomy in LVSD patients has been relatively contraindicated given the high risk for peri-procedural events and its lack of evidence. This study demonstrates that atherectomy in patients with CAC and severe LVSD is both safe and effective. OA was associated with significantly decreased fluoroscopy time and post-procedural heart failure compared with RA. Vessel preparation with atherectomy is vital in contemporary PCI, especially in patients with severe LVSD given modern generation scaffolds.