Procedural and Long-Term Ischemic Outcomes of Tight Subtotal Occlusions Treated with Orbital Atherectomy: An ORBIT II Subanalysis |
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| Institution: | 1. UCLA Medical Center, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA;2. St. Francis Hospital—The Heart Center, 100 Port Washington Blvd., Suite 105, Roslyn, NY 11576, USA;3. Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY 10017, USA;4. Scientific Affairs, Cardiovascular Systems, Inc., 1225 Old Highway 8 NW, St. Paul, MN 55112, USA;5. IU Health Physicians Cardiology, 1801 N. Senate Blvd., Suite 310, Indianapolis, IN 46202, USA;6. Metropolitan Heart and Vascular Institute, Mercy Hospital, 4040 Coon Rapids Blvd, Minneapolis, MN 55433, USA;1. San Carlo Clinic, Milano, Italy;2. Universitá degli Studi Milano-Bicocca, Milan, Italy;3. Radboud UMC, Nijmegen, Netherlands;1. Howard University Hospital, United States of America;2. West Virginia University, United States of America;3. University of Iowa Hospitals and Clinics, United States of America;1. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota;2. Columbia University, New York, New York;3. Henry Ford Hospital, Detroit, Michigan;4. Massachusetts General Hospital, Boston, Massachusetts;5. Beth Israel Deaconess Medical Center, Boston, Massachusetts;6. VA San Diego Healthcare System and University of California San Diego, La Jolla, California;7. Baylor Heart and Vascular Hospital, Dallas, Texas;8. Medical Center of the Rockies, Loveland, Colorado;9. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;10. VA Central Arkansas Healthcare System, Little Rock, Arkansas;11. Meshalkin Novosibrisk Research Institute, Novosibirsk, Russia;12. The Heart Hospital Baylor Plano, Plano, Texas;13. Torrance Memorial Medical Center, Torrance, California;14. Piedmont Heart Institute, Atlanta, Georgia;15. VA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota;p. Red Cross Hospital of Athens, Athens, Greece;q. Cleveland Clinic, Cleveland, Ohio;r. Emory University Hospital Midtown, Atlanta, Georgia;s. Tristar Centennial Medical Center, Nashville, Tennesse;t. Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary;u. VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas |
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| Abstract: | Background/purposeOrbital atherectomy is an effective treatment strategy to modify severely calcified coronary lesions prior to stent placement. Traversing a severely calcified subtotal occlusion with the crown may be more challenging compared with a less severely stenotic lesion. The purpose of this ORBIT II subanalysis was to evaluate outcomes post-orbital atherectomy (OA) treatment of lesions with ≥95% stenosis.Methods/materialsORBIT II, a single-arm, prospective, multicenter trial, enrolled 443 subjects with severely calcified coronary lesions. Patients with chronic total occlusions were excluded from the trial. Subjects with the OA device activated were stratified based on pre-procedure percent stenosis: ≥95% stenosis (N = 91) and <95% stenosis (N = 341). Procedural success and 3-year major adverse cardiac event (MACE) rates were compared.ResultsThe severe angiographic complications rates were 6.6% and 6.7% in the ≥95% and <95% stenosis groups, respectively. There was no significant difference in procedural success (94.5% vs. 88.3%, p = 0.120). 3-year MACE rates were similar (27.1% vs. 22.5%, p = 0.548), as were the rates of cardiac death (5.7% vs. 7.1%, p = 0.665) and MI (7.9% vs. 12.1%, p = 0.244). The TVR rate was higher in the ≥95% stenosis group (19.1% vs. 7.5%, p = 0.004).ConclusionsIn ORBIT II, OA treatment of lesions with ≥95% stenosis resulted in a high rate of procedural success. Although the 3-year revascularization rate was higher in the ≥95% stenosis group, it is not unexpected given the challenge of treating such complex lesions. The results of this analysis suggest that OA may be a reasonable treatment strategy for tight, severely calcified subtotal occlusions.SummaryThe purpose of this ORBIT II subanalysis was to evaluate outcomes post-orbital atherectomy (OA) treatment of lesions with ≥95% stenosis. In ORBIT II, OA treatment of lesions with ≥95% stenosis resulted in a high rate of procedural success. Although the 3-year revascularization rate was higher in the ≥95% stenosis group, it is not unexpected given the challenge of treating such complex lesions. The results of this analysis suggest that OA may be a reasonable treatment strategy for tight, severely calcified subtotal occlusions. |
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