Clinical Outcomes of Atherectomy Prior to Percutaneous Coronary Intervention: A Comparative Assessment of Atherectomy in Patients With Obesity (COAP-PCI Subanalysis).

OBJECTIVES: The aim of this study was to investigate the safety and efficacy of atherectomy devices in obese patients with coronary artery calcification (CAC).

BACKGROUND: Atherectomy is an important tool for lesion preparation in patients with CAC undergoing percutaneous coronary intervention (PCI). There have been no studies that compared the outcomes of orbital atherectomy (OA) and rotational atherectomy (RA) in obese patients.

METHODS: A total of 35,590 patients from five tertiary-care hospitals who underwent PCI between January 2011 to April 2016 were identified. All adult patients with body mass index ≥30 kg/ m2 who had OA or RA prior to PCI were included in this analysis. A total of 91 patients were included in the OA arm and 131 patients in the RA arm prior to the matching. To remove potential selection bias, a propensity-score matched analysis was performed, and 69 patients were included in each group.

RESULTS: The primary endpoint, composite of safety outcomes, did not occur in any patient of either group. The secondary endpoints - death on discharge (0.0% vs 1.5%; P=.48) and myocardial infarction (2.9% vs 6.4%; P=.42) - were similar between groups, as were individual outcomes including cardiogenic shock, bleeding complications, and congestive heart failure. Stroke, vascular complications, and the requirement for dialysis initiation did not occur in any of the patients.

CONCLUSION: In this study assessing atherectomy in obese patients, OA and RA demonstrated comparable outcomes with complication rates within an acceptable range. It demonstrates that OA and RA can be safely performed in this high-risk patient subset with CAC.