Author + information
- Rajkumar Doshi,
- Evan Shlofmitz,
- Amitkumar Patel,
- Barry Kaplan,
- Rajiv Jauhar and
- Perwaiz Meraj
Patients with coronary artery calcification (CAC) undergoing percutaneous coronary intervention (PCI) can often benefit from treatment with atherectomy for lesion preparation. Calcified coronary lesions and advanced age both independently increase the risk of successful PCI. There here have been no studies that have compared the head-to-head outcomes of orbital atherectomy (OA) and rotational atherectomy (RA) in the elderly. We sought to examine the safety and efficacy of atherectomy modalities in elderly patients with CAC.
This prospective, observational, multicenter study assessed OA vs. RA in elderly patients with CAC. 35,590 patients from 5 tertiary care hospitals who had PCI between January 2011 and April 2016 were identified. All patients 75 years of age or older, who had OA or RA prior to PCI were included in our analysis (n=310).
There were 117 patients in the OA arm and 193 patients in the RA group (Table 1a). Procedural data is presented in Table 1b. The primary endpoint, death on discharge occurred significantly less in patients in the OA group (0% vs. 1.55%, p=0.034). Myocardial infarction occurred more frequently in patients treated with OA, while patients undergoing RA had increased number of transfusions (Table 1c). Fluoroscopy time was significantly decreased with OA compared with RA.
Atherectomy in the elderly, a high risk subset of patients, with CAC has been minimally studied. In this first head-to-head analysis of elderly patients with CAC undergoing atherectomy prior to PCI we have demonstrated the safety of both OA and RA with excellent procedural success. OA was associated with significantly lower mortality, need for transfusion, and fluoroscopy time compared with RA, however there were decreased myocardial infarctions in patients treated with RA.