title: Orbital atherectomy treatment of severely calcified coronary lesions in patients with impaired left ventricular ejection fraction: one-year outcomes from the ORBIT II study.
abstract: OBJECTIVE
  Percutaneous coronary intervention (PCI) of severe coronary artery calcification (CAC) is challenging. The ORBIT II study demonstrated the safety and efficacy of orbital atherectomy (OA) in patients with severe CAC. Microparticulate liberated during OA may disturb the coronary microcirculation. In the present study, we evaluated OA treatment in patients with left ventricular systolic dysfunction.
  
  
  RESULTS
  Patients were grouped by left ventricular ejection fraction (LVEF): 26-40% (n=33), 41-50% (n=90), and >50% (n=314). Procedural success was similar (LVEF 26-40%: 90.9%, LVEF 41-50%: 88.9%, LVEF >50%: 88.4%). Rates of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, and target vessel revascularisation, were similar in the LVEF 26-40%, 41-50%, and >50% groups, respectively, at 30 days (9.1%, 7.8%, 11.5%) and one year (18.2%, 19.1%, 16.0%). Although the 30-day cardiac death rate was 0% in patients with left ventricular dysfunction, one-year cardiac death was higher compared with patients with preserved left ventricular systolic function.
  
  
  CONCLUSIONS
  No patient with left ventricular systolic dysfunction experienced cardiac death at 30 days suggesting that OA was well tolerated without haemodynamic complication. However, one-year cardiac death was higher in patients with left ventricular systolic dysfunction, consistent with previous studies demonstrating the association between reduced left ventricular function and increased mortality after PCI.
authors.affiliation: UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Martinsen
authors.forename: Richard
authors.initials: R
authors.lastname: Shlofmitz
authors.forename: Evan
authors.initials: E
authors.lastname: Shlofmitz
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Lee
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Chambers
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000601:surgery; D016277:Ventricular Function, Left / Q000502:physiology*