Denver VA Medical Center, University of Colorado, Denver, CO, United States of America.
Denver VA Medical Center, University of Colorado, Denver, CO, United States of America.
Cardiovasc Revasc Med. 2021 May;26:34-38. doi: 10.1016/j.carrev.2020.10.023. Epub 2020 Nov 1.
This study evaluated the safety and efficacy of orbital atherectomy (OA) for the treatment of severely calcified coronary artery bifurcation lesions.
Percutaneous coronary intervention (PCI) of severely calcified coronary artery lesions is associated with lower procedural success and higher rates of target lesion failure compared to non-calcified lesions. OA is an effective treatment for calcified coronary artery lesions prior to stent implantation. However, there is little data regarding the safety and efficacy of OA in patients with coronary artery bifurcation lesions.
Data were obtained from analysis of patients with severe coronary artery calcification who underwent OA and coronary stent implantation at ten high-volume institutions. Data were pooled and analyzed to assess peri-procedural outcomes and 30-day major adverse cardiac events (MACE).
A total of 1156 patients were treated with OA and PCI. 363 lesions were at a coronary artery bifurcation. There were no statistically significant differences in baseline characteristics between the bifurcation and non-bifurcation groups. In the bifurcation group, treatment involved the left anterior descending artery and its branches more frequently and right coronary artery less frequently. After propensity score matching, the 30-day freedom from MACE was not statistically significant between the two groups.
In this multicenter cohort analysis, patients with severely calcified coronary bifurcation lesions had low rates of MACE and target vessel revascularization at 30 days at rates comparable to non-bifurcation lesions. This analysis demonstrates that OA is safe and effective for complex coronary lesions at both bifurcation and non-bifurcation locations.
本研究评估了经皮腔内冠状动脉旋磨术（orbital atherectomy，OA）治疗严重钙化冠状动脉分叉病变的安全性和有效性。
与非钙化病变相比，经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）严重钙化冠状动脉病变的手术成功率较低，靶病变失败率较高。OA 是支架植入前治疗钙化冠状动脉病变的有效方法。然而，关于冠状动脉分叉病变患者 OA 的安全性和有效性的数据较少。
从十个高容量机构接受 OA 和冠状动脉支架植入术的严重冠状动脉钙化患者的分析中获得数据。汇总和分析数据以评估围手术期结局和 30 天主要不良心脏事件（major adverse cardiac events，MACE）。
共有 1156 例患者接受 OA 和 PCI 治疗。363 个病变位于冠状动脉分叉处。分叉组和非分叉组的基线特征无统计学差异。在分叉组中，更频繁地治疗左前降支及其分支，而较少治疗右冠状动脉。经过倾向评分匹配后，两组 30 天无 MACE 的比例无统计学差异。
在这项多中心队列分析中，严重钙化冠状动脉分叉病变患者的 30 天 MACE 和靶血管血运重建率较低，与非分叉病变的比率相当。该分析表明，OA 对分叉和非分叉部位的复杂冠状动脉病变均安全有效。
