title: Impact of Advanced Age on Procedural and Acute Angiographic Outcomes in Patients Treated for Peripheral Artery Disease With Orbital Atherectomy: A CONFIRM Registries Subanalysis.
abstract: OBJECTIVE
  Data on the outcomes of elderly patients with peripheral arterial disease (PAD) who undergo orbital atherectomy are limited. This analysis compares the procedural and acute angiographic outcomes of PAD patients treated with orbital atherectomy stratified by age (≥ 75 years of age [elderly] vs <75 years of age [younger]).
  
  
  METHODS
  The CONFIRM registry series with non-missing age was analyzed and included 2995 real-world PAD patients (4557 lesions) with 1753 younger patients (2637 lesions) and 1242 elderly patients (1920 lesions) treated with orbital atherectomy. The composite rate of adverse events including dissection, perforation, slow flow, vessel closure, spasm, embolism, and thrombus formation was compared between groups.
  
  
  RESULTS
  Elderly patients had a higher proportion of females (47.5% vs 35.3%; P<.001), more patients with critical limb ischemia (49.9% vs 39.3%; P<.001), longer lesion length (75.0 ± 74.1 mm vs 69.9 ± 68.9 mm; P=.01), and more lesions treated below the knee (38.9% vs 34.4%; P=.01). Younger and elderly patients had similar rates of composite adverse events (22.0% vs 21.3%; P=.81), dissection (11.4% vs 10.5%; P=.72), vessel closure (1.7% vs 1.1%; P=.13), spasm (6.3% vs 6.4%; P=.96), and embolism (2.5% vs 1.6%; P=.31). Elderly patients had a lower rate of thrombus formation (0.9% vs 1.6%; P=.03), but a higher perforation rate (1.2% vs 0.4%; P=.01).
  
  
  CONCLUSIONS
  Orbital atherectomy resulted in similar composite rates of adverse events despite the elderly having unfavorable baseline Rutherford classification and lesion characteristics. The higher rate of perforation may be explained by longer and more below-the-knee lesions.
authors.affiliation: Departments of Medicine and Cardiology, UCLA Medical Center, Los Angeles, California, USA. mslee@mednet.ucla.edu.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Robert
authors.initials: R
authors.lastname: Beasley
authors.forename: George L
authors.initials: GL
authors.lastname: Adams
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D055109:Ankle Brachial Index; D017073:Atherectomy / Q000379:methods*; D002114:Calcinosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult