Abstract

Objective

Coronary artery calcification (CAC) is one of the paramount hurdles for percutaneous coronary intervention (PCI) since it impedes stent delivery and complete expansion. This study intended to evaluate the short-term clinical and procedural outcomes comparing rotational atherectomy (RA) and orbital atherectomy (OA) in patients with heavily calcified coronary lesions undergoing PCI. Design: This systematic review and meta-analysis included all head-to-head published comparisons of coronary RA versus OA. Procedural endpoints and post-procedural clinical outcomes (30 days/in-hospital), were compared. RevMan 5.3 software was used for data analysis. Results: Seven retrospective observational investigations with a total of 4623 patients, including 3203 patients in the RA group and 1420 patients in the OA group, were incorporated. Compared with OA, the RA group was associated with a higher incidence of myocardial infarction at short-term follow-up (OR: 1.56, 95% CI: 1.07–2.29, p = .02, I² = 0%). No difference was noted among other short-term post-procedural clinical outcomes including all-cause mortality, target vessel revascularization, or major adverse cardiac events. Among procedural complications, RA was associated with reduced coronary artery dissection and arterial perforation. Increased fluoroscopy time was observed in the RA cohort as compared with OA (MD: 4.78, 95% CI: 2.25–7.30, p = .0002, I² = 80%). Conclusion: RA was associated with fewer vascular complications, but at a cost of higher incidence of myocardial infarction and higher fluoroscopy time compared with OA, at short term follow-up. OA is a safe and effective alternative for the management of CAC.

中文翻译：

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复杂经皮冠状动脉介入治疗患者旋磨与眼眶旋磨的短期结果：系统评价和荟萃分析

摘要

客观的

冠状动脉钙化 (CAC) 是经皮冠状动脉介入治疗 (PCI) 的主要障碍之一，因为它会阻碍支架输送和完全扩张。本研究旨在评估在接受 PCI 的冠状动脉严重钙化病变患者中，比较旋磨 (RA) 和眼眶旋切术 (OA) 的短期临床和手术结果。设计：这项系统评价和荟萃分析包括所有公开发表的冠状动脉 RA 与 OA 的比较。比较了手术终点和手术后临床结果（30 天/住院）。RevMan 5.3软件用于数据分析。结果：纳入了 7 项回顾性观察性调查，共 4623 名患者，其中 RA 组 3203 名患者和 OA 组 1420 名患者。与 OA 相比，RA 组在短期随访中与更高的心肌梗死发生率相关（OR：1.56，95% CI：1.07–2.29，p  = .02，I ² = 0%）。在其他短期术后临床结果（包括全因死亡率、靶血管血运重建或主要不良心脏事件）之间没有发现差异。在手术并发症中，RA 与减少冠状动脉夹层和动脉穿孔有关。与 OA 相比，在 RA 队列中观察到透视时间增加（MD：4.78，95% CI：2.25-7.30，p  = .0002，I ² = 80%）。结论：在短期随访中，与 OA 相比，RA 与较少的血管并发症相关，但代价是心肌梗塞的发生率更高，透视时间更长。OA 是一种安全有效的 CAC 管理替代方案。