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With an aging population and increasing risk factors for coronary artery calcification (CAC), a rising number of percutaneous coronary interventions (PCI) involve the treatment of CAC. Consequently, adjunctive atherectomy has become an important part of PCI. While rotational atherectomy (RA) has been available for decades, orbital atherectomy (OA) is a newer modality. We sought to examine the acute outcomes of patients treated with RA versus OA.
This meta-analysis included all head-to-head published comparisons of coronary RA versus OA. Procedural and acute outcomes were compared. Procedural outcomes analyzed included dissection, perforation, and cardiac tamponade. Acute clinical endpoints included myocardial infarction (MI) and all-cause mortality reported as either in-hospital or at 30 days. Studies that did not report raw data on procedural or acute outcomes were excluded from this analysis.
Three studies with total of 1661 patients were included in the study, representing 1181 patients treated with RA and 480 with OA. The risk of MI favored OA (RR: 1.44; 95% CI: 1.00-2.08, p=0.05). There was no significant difference in procedural complications of coronary dissection, perforation, cardiac tamponade, and all-cause mortality (Figure 1).
This is the first meta-analysis comparing RA and OA. There was a similar safety profile between the devices, with a less frequent incidence of MI following OA, which may have important clinical significance.