Lee Michael S, Shlofmitz Richard A, Martinsen Brad J, Sethi Sanjum, Chambers Jeffrey W
UCLA Medical Center, Los Angeles, CA, United States.
St. Francis Hospital-The Heart Center, Roslyn, NY, United States.
Cardiovasc Revasc Med. 2018 Sep;19(6):655-659. doi: 10.1016/j.carrev.2018.01.011. Epub 2018 Jan 31.
We investigated the safety and efficacy of coronary orbital atherectomy to treat severely calcified lesions prior to stenting based upon age.
The ORBIT II study reported the safety and efficacy with orbital atherectomy in 443 patients with severely calcified lesions. Elderly patients undergoing percutaneous coronary intervention may be at increased risk for major adverse cardiac events (MACE) and death compared with younger patients.
Patients were stratified according to age (≥75 year old [174/443, 39.3%] vs. <75 year old [269/443, 60.7%]). The MACE rate, defined as cardiac death, myocardial infarction (CK-MB > 3X ULN), and target vessel revascularization, was examined at 30-day and 3-year follow-up.
Elderly and non-elderly groups had similar rates of procedural (87.9% vs. 89.5%, p = 0.64) and angiographic success (91.4% vs. 91.4%, p = 1.00). Severe angiographic complications were also similar in both groups (6.9% vs. 7.4%, p = 1.00). There was no statistically significant difference in MACE rates in the elderly and younger groups at 30 days (10.9% vs. 10.1%; p = 0.76) and 3 years (27.8% vs. 20.7%, p = 0.13). The individual endpoints of cardiac death (9.1% vs. 5.1%, p = 0.14), myocardial infarction (13.4% vs. 9.7%, p = 0.27), and target vessel revascularization (10.6% vs. 10.0%, p = 0.91) were also similar in both groups at 3 years.
The rates of adverse clinical events in elderly patients who underwent orbital atherectomy were low and similar to the non-elderly patients, suggesting that it could be a reasonable treatment strategy for elderly patients with severely calcified lesions.
我们根据年龄研究了冠状动脉轨道旋磨术在支架置入术前治疗严重钙化病变的安全性和有效性。
ORBIT II研究报告了443例严重钙化病变患者接受轨道旋磨术的安全性和有效性。与年轻患者相比，接受经皮冠状动脉介入治疗的老年患者发生主要不良心脏事件（MACE）和死亡的风险可能更高。
根据年龄将患者分层（≥75岁[174/443，39.3%]与<75岁[269/443，60.7%]）。在30天和3年随访时检查MACE发生率，MACE定义为心源性死亡、心肌梗死（CK-MB>3倍ULN）和靶血管血运重建。
老年组和非老年组的手术成功率（87.9%对89.5%，p = 0.64）和血管造影成功率（91.4%对91.4%，p = 1.00）相似。两组严重血管造影并发症发生率也相似（6.9%对7.4%，p = 1.00）。老年组和年轻组在30天时的MACE发生率（10.9%对10.1%；p = 0.76）和3年时（27.8%对20.7%，p = 0.13）无统计学显著差异。两组在3年时的心源性死亡（9.1%对5.1%，p = 0.14）、心肌梗死（13.4%对9.7%，p = 0.27）和靶血管血运重建（10.6%对10.0%，p = 0.91）等个体终点也相似。
接受轨道旋磨术的老年患者不良临床事件发生率较低，与非老年患者相似，这表明对于有严重钙化病变的老年患者，这可能是一种合理的治疗策略。
