Author + information
- Emily Perdoncin1,
- Milan Seth1,
- Theodore Schreiber2,
- Akshay Khandelwal3,
- Simon Dixon4 and
- Hitinder Gurm5
- 1University of Michigan, Ann Arbor, Michigan, United States
- 2Detroit Medical Center, Detroit, Michigan, United States
- 3Henry Ford Hospital, Northville, Michigan, United States
- 4Beaumont Hospital, Royal Oak, Michigan, United States
- 5University of Michigan Medical Center, Ann Arbor, Michigan, United States
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.
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.
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%, p=0.021), a higher rate of significant dissection (1.7% vs. 0.6%, p=0.065), and more bleeding events within 72 hours (7.4% vs. 4.2%, p=0.014). There was no significant difference in the rate of CABG (0.4% vs. 0.4%, p=0.856), death (2.6% vs. 1.9%, p=0.407), or myocardial infarction (5.5% vs. 4.8%, p=0.587) between RA versus OA, respectively.
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.
CORONARY: Atherectomy (excluding thrombectomy)