Abstract 13828: Lesion Length and Left Ventricular Function Predict Outcome in Patients Undergoing Orbital Atherectomy Prior to Stenting for Severely Calcified Coronary Lesions

Introduction: Orbital atherectomy prior to stenting (OAptS) of severely calcified coronary lesions may improve procedural outcomes. However, there is little data identifying specific procedural/clinical factors influencing these outcomes. In this study, we examined the hypothesis that both lesion length and left ventricular ejection (LVEF) influence overall clinical outcomes for OAptS. Methods: Between November 1, 2015 and December 31, 2019, clinical data and coronary angiograms for all patients undergoing OAptS for severely calcified coronary lesions at our institution were retrospectively reviewed. Patients were first grouped by lesion length (focal ≤24mm and diffuse >24mm), then subdivided into normal (≥50%) and reduced (<50%) LVEF groups. Demographics, procedural variables and clinical outcomes for all four groups were then analyzed and compared. Results: In total, 213 lesions were analyzed (74 focal and 139 diffuse). There was no significant difference in demographics between all four patient groups. Average target lesion stent lengths were longer for diffuse compared to focal lesions (38.1±1.7mm vs. 17.2±0.8mm; p<0.001). Fluoroscopy time was longer in patients with diffuse lesions (p< 0.05), with no significant difference in contrast volumes between all groups (p=NS). The baseline LVEF was lower in patients with diffuse lesions (50.6±13% vs. 54.8±12%; p<0.05). Thirty-day time-to-event analysis (Mantel-Cox) demonstrated earlier and more frequent death/MACE/bleeding in the patient group with both diffuse lesions and reduced LVEF (p<0.01). Death, MACE and bleeding was not statistically different between the other three subgroups. Conclusions: In conclusion, our single center, retrospective analysis demonstrates the general safety of OAptS for treating severely calcified coronary lesions of different lengths in patients with normal and reduced LVEF. In addition, it identifies a high-risk patient subgroup (diffuse lesion length and reduced LVEF) at increased risk for a worse procedural outcome.