Contemporary use and outcomes associated with rotational versus orbital atherectomy in percutaneous coronary interventions

Authors

Simon Dixon, Beaumont Hospital

Document Type

Article

Publication Date

10-2017

Abstract

BACKGROUND Atherectomy devices have been used with the goal of improving outcomes during percutaneous coronary intervention (PCI) of heavily calcified lesions. There is a paucity of contemporary data evaluating the safety and efficacy of orbital atherectomy versus rotational atherectomy in real world practice.

METHODS We evaluated the outcomes of 1,641 patients who underwent PCI using either rotational atherectomy (RA) or orbital atherectomy (OA) from 2014-2016 at 33 hospitals in Michigan participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. RESULTS The rate of use of both strategies has increased since 2014, although over-all use remains low (1.6% RA vs. 1.1% OA). There was a higher rate of perforation with RA than with OA (1.8% vs. 0.4%, p¼0.021), a higher rate of significant dissection (1.7% vs. 0.6%, p¼0.065), and more bleeding events within 72 hours (7.4% vs. 4.2%, p¼0.014). There was no significant difference in the rate of CABG (0.4% vs. 0.4%, p¼0.856), death (2.6% vs. 1.9%, p¼0.407), or myocardial infarction (5.5% vs. 4.8%, p¼0.587) between RA versus OA, respectively. CONCLUSION Use of atherectomy during PCI remains low, but is steadily increasing. Orbital atherectomy as opposed to rotational atherectomy was associated with a slightly lower rate of complications including dissection, perforation, and bleeding but with no difference in death, MI, or CABG. Further study is needed to determine whether the observed difference in procedural outcomes is device or lesion related.

CONCLUSION Use of atherectomy during PCI remains low, but is steadily increasing. Orbital atherectomy as opposed to rotational atherectomy was associated with a slightly lower rate of complications including dissection, perforation, and bleeding but with no difference in death, MI, or CABG. Further study is needed to determine whether the observed difference in procedural outcomes is device or lesion related.

Comments

National Cardiogenic Shock Initiative (NCSI), Denver, CO, October 26, 2017.

Recommended Citation

Perdoncin E, Seth M, Schrieber T, Khandelwal A, Dixon SR, Gurm H. Contemporary use and outcomes associated with rotational versus orbital atherectomy in percutaneous coronary interventions: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. National Cardiogenic Shock Initiative (NCSI), Denver, CO, October 26, 2017.