Impact of age following treatment of severely calcified coronary lesions with the orbital atherectomy system: 3-year follow-up.

OBJECTIVES: We investigated the safety and efficacy of coronary orbital atherectomy to treat severely calcified lesions prior to stenting based upon age.

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.