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Orbital, rotational atherectomy similarly successful in treating calcified CAD

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SAN FRANCISCO — Orbital and rotational atherectomy conferred similar outcomes in patients with calcified CAD who underwent PCI, according to the results of a retrospective cohort study presented at TCT 2019.

The researchers analyzed 2,994 patients who underwent PCI with orbital or rotational atherectomy at one of 48 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium between January 2014 and March 2018.

Devika Aggarwal, MBBS, internal medicine resident at the University of Michigan, presented the findings, which were simultaneously published in JACC: Cardiovascular Interventions.

According to the researchers, the following in-hospital outcomes were similar between the groups:

• procedural success, defined as residual stenosis 30% or less: orbital, 94.2%; rotational, 94.6%; adjusted OR = 0.85; 95% CI, 0.59-1.25;
• perfect procedural success, defined as residual stenosis 10% or less: orbital, 88.6%; rotational, 86.8%; aOR = 1.14; 95% CI, 0.87-1.47;
• perforation: aOR = 0.78; P = .49;
• National Cardiovascular Data Registry-defined bleeding: aOR = 0.89; P = .48;
• major bleeding, defined as a drop in hemoglobin of at least 5 g/dL: aOR = 0.69; P = .43;
• stent thrombosis: aOR = 1.85; P = .52;
• persistent no reflow: aOR = 1.91; P = .11;
• emergency or salvage CABG: aOR = 0.81; P = .9; and
• all-cause mortality: aOR = 0.87; 95% CI, 0.5-1.5.

Use of both technologies rose between 2014 and 2018 (P < .001 for trend for both), but the rate of growth for orbital atherectomy was faster than for rotational atherectomy, and their use was almost equal by the first quarter of 2018, according to the researchers.

“To our knowledge, this is the largest observational study examining the changing patterns of use, and comparative outcomes of orbital atherectomy and rotational atherectomy,” Aggarwal and colleagues wrote in JACC: Cardiovascular Interventions. “There has been an increase in overall use of atherectomy and the growth in orbital atherectomy does not appear to have supplanted rotational atherectomy use. Our findings corroborate and extend prior smaller studies that have demonstrated broadly similar outcomes with the two competing atherectomy modalities.” – by Erik Swain

References:

Aggarwal D, et al. Abstract 25. Presented at: TCT Scientific Symposium; Sept. 25-29, 2019; San Francisco.

Aggarwal D, et al. JACC Cardiovasc Interv. 2019;doi:10.1016/j.jcin.2019.09.027.

Disclosures: The authors report no relevant financial disclosures.