Donatelle Marissa, Agasthi Pradyumna, Parise Helen, Igyarto Zsuzsanna, Martinsen Brad J, Leon Martin B, Beohar Nirat
Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140 USA.
J Invasive Cardiol. 2022 Oct;34(10):E696-E700. doi: 10.25270/jic/22.00066.
Orbital atherectomy (OA) has been shown to be safe and effective in patients with severe calcific coronary artery disease; however, there is a paucity of data on OA use in patients with concomitant severe aortic stenosis (AS).
A retrospective analysis of consecutive patients undergoing coronary OA treatment of severely calcified lesions, from January 2014 to September 2020 at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB), was completed. Data were analyzed to assess rates of angiographic complications, successful stent placement, and in-hospital major adverse cardiovascular event (MACE; defined as the composite of cardiac death, myocardial infarction, ischemic cerebrovascular accident [CVA], and hemorrhagic CVA) in AS vs non-AS patients.
A total of 609 patients underwent OA; of those, 32 (5.3%) had severe AS. The AS patient cohort was significantly older (80.3 years vs 73.7 years; P<.001), with a significantly higher percentage of Hispanic or Latino individuals (75% vs 56.5%; P=.04) and lower estimated glomerular filtration rate (64.6 mL/min/1.73 m² vs 76.6 mL/min/1.73 m²; P =.03) than the non-AS cohort. Angiographic complication rates were similar and both groups resulted in 100% successful stent placement. There was no difference in MACE rates between the AS and non-AS cohorts (3.1% vs 1.4%; P=.39).
This study represents the largest real-world comparison of OA use in AS vs non-AS patients. OA appears feasible, safe, and effective prior to stent placement in patients with severe AS. Prospective randomized trials are needed to determine the ideal revascularization strategy for AS patients.
轨道旋磨术（OA）已被证明在严重钙化冠状动脉疾病患者中是安全有效的；然而，关于OA在合并严重主动脉瓣狭窄（AS）患者中的应用数据较少。
对2014年1月至2020年9月在佛罗里达州迈阿密海滩西奈山医疗中心（MSMCMB）接受冠状动脉OA治疗严重钙化病变的连续患者进行回顾性分析。分析数据以评估AS患者与非AS患者的血管造影并发症发生率、支架成功置入率和院内主要不良心血管事件（MACE；定义为心源性死亡、心肌梗死、缺血性脑血管意外[CVA]和出血性CVA的复合事件）发生率。
共有609例患者接受了OA治疗；其中32例（5.3%）患有严重AS。AS患者队列年龄显著更大（80.3岁对73.7岁；P<0.001），西班牙裔或拉丁裔个体比例显著更高（75%对56.5%；P = 0.04），估计肾小球滤过率更低（64.6 mL/min/1.73 m²对76.6 mL/min/1.73 m²；P = 0.03），高于非AS队列。血管造影并发症发生率相似，两组均实现了100%的支架成功置入。AS队列和非AS队列的MACE发生率无差异（3.1%对1.4%；P = 0.39）。
本研究是AS患者与非AS患者使用OA的最大规模真实世界比较。OA在严重AS患者支架置入前似乎是可行、安全且有效的。需要进行前瞻性随机试验以确定AS患者的理想血运重建策略。
