In‑hospital outcomes of rotational versus orbital atherectomy during percutaneous coronary intervention: a meta‑analysis

Kamil Zieliński, Łukasz Kołtowski*, Łukasz Kalińczuk, Gary S Mintz, Janusz Kochman, Adam Witkowski, Jerzy Pręgowski, Daria Motyl, Roberto Lorusso, Piotr Suwalski, Mariusz Kowalewski

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)

Abstract

BACKGROUND: Data comparing rotational atherectomy (RA) with orbital atherectomy (OA) for calcified lesions is inconclusive and based on single observational studies in populations with limited numbers of patients.

AIMS: The aim of the study was to perform a meta‑analysis of observational studies comparing RA with OA for calcified lesions prior to percutaneous coronary intervention.

METHODS: Electronic databases were searched for studies comparing short‑term outcomes of RA with OA prior to percutaneous coronary intervention. Risk ratios (RRs) or mean differences (MD) and 95% confidence intervals (CIs) were calculated using a random‑effects model.

RESULTS: Meta‑analysis included 6 retrospective studies with 1590 patients treated with RA and 721 with OA. The latter was associated with shorter fluoroscopy time (MD, -3.40 min; 95% CI, -4.76 to -2.04; P <0.001, I2 = 0%), but contrast use was similar (MD, -2.78 ml; 95% CI, -16.04 to 10.47; P = 0.68; I2 = 67%). Although coronary dissection occurred 4‑fold more frequently with OA (RR, 3.87; 95% CI, 1.37-10.93; P = 0.01; I2 = 0%), perforations (RR, 2.73; 95% CI, 0.46-16.30, P = 0.27; I2 = 41), tamponade (RR, 1.78; 95% CI, 0.37-8.58; P = 0.47; I2 = 0%), and slow or no‑reflow phenomenon (RR, 0.81; 95% CI, 0.35-1.84; P = 0.61; I2 = 0%) occurred with similar frequency. The risk of 30‑day or in‑hospital myocardial infarction was lower in OA as compared with RA (RR, 0.67; 95% CI, 0.47-0.94; P = 0.02; I2 = 0%), yet the risk of in‑hospital mortality (RR, 0.73; 95% CI, 0.11-4.64; P = 0.74; I2 = 43%) and length of stay (MD, -0.27 days; 95% CI, -0.76 to -0.23; P = 0.29; I2 = 0%) did not differ.

CONCLUSIONS: Orbital atherectomy was associated with a lower risk of early myocardial infarction. However, a higher rate of coronary dissections produced by OA did not translate into increased risk of perforations, slow or no‑reflow phenomenon, or in‑hospital mortality.

Original languageEnglish
Pages (from-to)846-852
Number of pages7
JournalKardiologia Polska
Volume77
Issue number9
DOIs
Publication statusPublished - 23 Sep 2019

Keywords

  • Aged
  • Aged, 80 and over
  • Atherectomy, Coronary/adverse effects
  • Atherectomy/adverse effects
  • Coronary Stenosis/surgery
  • Female
  • Hospital Mortality
  • Hospitals
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction/etiology
  • No-Reflow Phenomenon/etiology
  • Percutaneous Coronary Intervention/adverse effects
  • Treatment Outcome
  • calcified stenosis
  • PLAQUE MODIFICATION
  • MICROCIRCULATORY RESISTANCE
  • MECHANISMS
  • IMPACT
  • atherectomy
  • INDEX
  • rotablation

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