title: Outcomes in Elderly Patients With Severely Calcified Coronary Lesions Undergoing Orbital Atherectomy.
abstract: OBJECTIVE
  We evaluated the clinical outcomes of elderly patients who underwent orbital atherectomy for the treatment of severe coronary artery calcification (CAC) prior to stenting.
  
  
  BACKGROUND
  Percutaneous coronary intervention (PCI) of severe CAC is associated with worse clinical outcomes including death, myocardial infarction (MI), and target vessel revascularization (TVR). The elderly represents a high-risk group of patients, often have more comorbid conditions, and have worse outcomes after PCI compared to younger patients. Clinical trials and a large multicenter registry have demonstrated the safety and efficacy of orbital atherectomy for the treatment of severe CAC. Clinical outcomes of elderly patients who undergo orbital atherectomy are unknown.
  
  
  METHODS
  Of the 458 patients, 229 were ≥75 years old (elderly) and 229 were <75 years old (younger). The primary endpoint was rate of 30-day major adverse cardiac and cerebrovascular events (MACCE), comprised of cardiac death, MI, TVR, and stroke.
  
  
  RESULTS
  The primary endpoint was similar in the elderly and younger groups (2.2% vs. 2.2%, P = 1), as were the individual endpoints of death (2.2% vs. 0.4%, P = 0.1), MI (0.9% vs. 1.3%, P = 0.65), TVR (0% vs. 0%, P = 1), and stroke (0% vs. 0.4%, P = 0.32). The rates of angiographic complications and stent thrombosis were similarly low in both groups.
  
  
  CONCLUSIONS
  The elderly represented a sizeable number of patients who underwent orbital atherectomy. It is a safe and effective treatment strategy for elderly patients with severe CAC as the clinical outcomes were similar to their younger counterparts. A randomized trial should further clarify the role of orbital atherectomy in these patients.
authors.affiliation: UCLA Medical Center, Los Angeles, California.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Northwell Health, Manhasset, New York.
authors.forename: Evan
authors.initials: E
authors.lastname: Shlofmitz
authors.affiliation: UCLA Medical Center, Los Angeles, California.
authors.forename: Gentian
authors.initials: G
authors.lastname: Lluri
authors.affiliation: St. Francis Hospital-The Heart Center, Roslyn, New York.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Shlofmitz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000601:surgery*