Acute outcomes after coronary orbital atherectomy at a single center without on-site surgical backup: An experience in diabetics versus non-diabetics

Background: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with a high risk of angiographic complication, incomplete stent expansion, and restenosis. The prevalence of calcification is increased in diabetics (DM) and the PCI outcome in this population is often suboptimal. Treatment with orbital atherectomy (OA) in severely calcified lesions has been shown to result in favorable procedural outcomes and low reintervention rates; in DM and non-DM. We sought to determine the acute safety of OA in a center without on-site surgical backup in DM and non-DM.

Methods: All comers treated with OA at Sanford Bemidji Heart and Vascular Center (Bemidji, MN) from 8/30/16 to 4/14/17 were included in this retrospective analysis. Baseline, procedure, and acute outcome data were compared in DM and non-DM patients.

Results: Of the 70 patients treated with OA, 40% were DM. History of hypertension and chronic renal disease were more prevalent in the DM group. Successful stent delivery occurred in 96.4% of DM and 100% in non-DM, respectively. None of the patients treated with OA died or experienced abrupt closure, severe dissection, embolization, or no reflow. The overall perforation and slow flow rates were 1.4%. One non-DM patient had a non-target vessel MI due to side branch closure.

Conclusions: Our study demonstrates the safety of OA in a center without on-site surgical backup. In this study, OA treatment resulted in a high rate of successful stent delivery and low rates of angiographic complications and acute MACE, in DM and non-DM patients.

Summary: In this retrospective study we sought to determine the acute safety of coronary orbital atherectomy treatment in a center without on-site surgical backup in diabetic and non-diabetic patients. None of the patients treated with orbital atherectomy died or experienced abrupt closure, severe dissection, embolization, or no reflow; the overall perforation and slow flow rates were 1.4% and one non-diabetic patient had a non-target vessel myocardial infarction due to side branch closure. Our study demonstrates the safety of orbital atherectomy in a center without on-site surgical backup; orbital atherectomy treatment resulted in a high rate of successful stent delivery and low rates of angiographic complications and acute major adverse cardiac events in diabetic and non-diabetic patients.