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History of prior coronary artery bypass grafting (CABG) may be associated with increased incidence of major adverse cardiac events (MACE) in patients undergoing repeat CABG, percutaneous coronary intervention, or medical treatment. In this analysis, one year safety outcomes were evaluated in patients with and without history of CABG treated with orbital atherectomy for de novo, severely calcified coronary lesions.
ORBIT II, a prospective, multicenter, non-blinded trial, enrolled 443 patients with severely calcified coronary lesions. Orbital atherectomy was used to modify lesions for stent placement. One year safety outcomes were compared in patients with and without history of CABG (N=65 and N=378).
ORBIT II patients with history of CABG were more likely to be male and have a higher prevalence of diabetes, history of dyslipidemia, hypertension, and myocardial infarction (MI). One year safety outcomes are presented in Table I. The higher rate of in-hospital MACE (16.9% vs. 8.5%, p=0.04) in the prior CABG group was likely driven by the higher rate of non-Q-wave MI (15.4% vs. 7.5%, p=0.05). At one year, however, using multivariate analysis prior CABG was not associated with increased MACE (HR 0.57, p=0.08) after adjusting for baseline and pre-procedural factors.
Preparation of severely calcified coronary lesions with orbital atherectomy facilitated stent delivery in patients with a history of CABG, resulting in low rates of 1-year MACE, MI, cardiac death, and target vessel revascularization.
|Prior CABG||No Prior CABG||p-value|
|Cardiac death (%)||4.7||2.7||0.41|
|Q-wave MI (%)||1.5||0.8||0.57|
|Non-Q-wave MI (CK-MB>3XULN) (%)||15.4||7.7||0.05|