Comparison of rotational and orbital atherectomy for the treatment of calcific coronary lesions: Insights from the VA clinical assessment reporting and tracking (CART) program

医学 心肌梗塞 内科学 心脏病学 血运重建 动脉切除术 传统PCI 冲程(发动机) 蒂米 临床终点 支架 穿孔 队列 靶病变 经皮冠状动脉介入治疗 外科 再狭窄 随机对照试验 机械工程 材料科学 工程类 冲孔 冶金
作者
Christopher Barrett,Theodore Warsavage,Christopher P. Kovach,Erin McGuinn,Mary E. Plomondon,Ehrin J. Armstrong,Stephen W. Waldo
出处
期刊:Catheterization and Cardiovascular Interventions [Wiley]
卷期号:97 (2) 被引量:10
标识
DOI:10.1002/ccd.28971
摘要

Abstract Background Previous studies suggested that pre‐treatment of coronary artery calcification (CAC) with rotational atherectomy (RA) prior to stent deployment improved procedural success but was not associated with a concomitant improvement in clinical outcomes. Orbital atherectomy (OA) has demonstrated similar benefits, though there are few data comparing the safety and efficacy of the two modalities. Methods Patients who underwent PCI of a native coronary lesion with RA or OA from 2014 to 2018 within the Veterans Affairs Healthcare System were identified. Propensity matched cohorts were generated to compare the clinical and safety outcomes following either RA or OA. The primary endpoint was the rate of 30‐day major adverse cardiovascular and cerebrovascular events (MACCE), including all‐cause mortality, repeat myocardial infarction, target vessel revascularization, and stroke. Results We identified 1,091 patients that underwent atherectomy during the study period, 640 (59%) treated with RA and 451 (41%) treated with OA. Among a propensity‐matched cohort consisting of 950 patients, there was no significant difference in MACCE for patients who underwent RA or OA (7.1 vs. 8.2%, p = .36). Components of the primary outcome including 30‐day mortality, myocardial infarction, target vessel revascularization, and stroke were also similar in the matched cohort. Additionally, procedural complications including perforation, no‐reflow, dissection, and in‐stent thrombosis were comparable across both treatment strategies. Conclusions Both rotational and orbital atherectomy are safe and effective strategies for the treatment of calcified coronary plaque prior to stent deployment, with similarly low rates of peri‐procedural adverse events.
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