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Lesion preparation is often essential in patients with coronary artery calcification (CAC) undergoing percutaneous coronary intervention (PCI). Patients with end-stage renal disease on hemodialysis have increased severity of CAC, increasing the complexity of PCI. There here have been no studies that have compared the head-to-head outcomes of dialysis patients undergoing orbital atherectomy (OA) compared to rotational atherectomy (RA).
This prospective, observational, multicenter study assessed OA vs. RA in dialysis patients with CAC. Thirty-five thousand five hundred ninety patients from 5 tertiary-care hospitals who had PCI between January 2011 and April 2016 were identified. Matched analysis of all dialysis patients who had OA or RA prior to PCI was performed (n=62).
There were 31 patients in each cohort. There was no significant difference in the primary endpoint, death on discharge (0% vs. 3.2%, p=0.31). Multivariate adjusted analysis demonstrated no statistically significant differences in procedural and in-hospital outcomes (Table 1).
Atherectomy in patients on dialysis, a complex, high-risk subset of patients, with CAC has not been well-studied. In this first head-to-head analysis of dialysis patients with CAC undergoing atherectomy prior to PCI, there were no significant differences between either modality, with low rates of procedural complications in both groups. Multicenter randomized studies are needed to confirm the optimal atherectomy strategy in this rarely studied patient population.
|Variable Name||OA (N=31)||RA (N=31)||P value|
|Fluoroscopy Time (min)||21.1±9.3||23.6±10.8||0.35|
|Contrast Volume (ml)||163.3±71.6||147.0±61.1||0.34|
|Significant Dissection||0 (0%)||1 (3.2%)||0.31|
|Perforation||0 (0%)||0 (0%)||N/A|
|Cardiac Tamponade||0 (0%)||0 (0%)||N/A|
|Vascular Complications||1 (3.2%)||0 (0%)||0.31|
|In-Hospital Mortality||0 (0%)||1 (3.2%)||0.31|
|Myocardial Infarction||3 (9.7%)||6 (19.3%)||0.28|
|Cardiogenic Shock||1 (3.2%)||2 (6.4%)||0.55|
|Congestive Heart Failure||0 (0%)||1 (3.2%)||0.31|
|Composite of Stroke||0 (0%)||0 (0%)||N/A|
|Blood Transfusion||4 (12.9%)||5 (16.1%)||0.72|
|Bleeding Within 72 Hours||1 (3.2%)||1 (3.2%)||1.00|
|Conversion to CABG||0 (0%)||0 (0%)||N/A|
|Length of Stay (Days)||4.4±7.0||5.5±9.4||0.58|