Orbital Atherectomy for Treatment of Complex Severely Calcified Coronary Artery Lesions: Insights from a Veterans Affairs Cohort.

BACKGROUND

Coronary artery calcification remains a significant challenge to successful percutaneous coronary intervention (PCI). Orbital atherectomy (OA) is an effective treatment for severely calcified coronary artery lesions during PCI, but few data are available in the Veterans Affairs (VA) system which has an increasingly complex subset of patients.

METHODS

Data were obtained from retrospective analysis of patients with severe coronary artery calcification who underwent OA followed by stent implantation from February of 2015 to July of 2018 at a single VA Medical Center. Kaplan-Meier analysis was utilized to assess the primary endpoints of 30-day and 1-year freedom from major adverse cardiac events [MACE: Cardiac Death, myocardial infarction (MI), or target vessel revascularization (TVR)].

RESULTS

Among 151 patients, baseline comorbidities included diabetes (57%), prior PCI (51%), congestive heart failure (36.4%), and prior coronary artery bypass grafting (23.2%). The most common indication for intervention was stable angina (54.3%). Seventeen percent of cases required hemodynamic support. Angiographic complication rates were low. Overall freedom from MACE was 96% at 30 days and 87.7% at 1 year.

CONCLUSION

This single-center VA cohort demonstrates that patients with severely calcified and anatomically complex coronary artery lesions treated with OA had a low rate of angiographic complications and a high rate of one-year freedom from MACE. Moreover, this study included demographics underrepresented in clinical trials, including those with acute myocardial infarction, left main coronary artery disease, and bifurcation lesions.