Outcomes of patients with myocardial infarction who underwent orbital atherectomy for severely calcified lesions

Abstract Objectives This study analyzed the outcomes of patients who presented with non-ST-elevation myocardial infarction (NSTEMI) and subsequently underwent orbital atherectomy for severe coronary artery calcification (CAC). Background Patients who present with NSTEMI have increased risk for death and recurrent MI after percutaneous coronary intervention (PCI). Patients with severe CAC have worse outcomes after PCI.Orbital atherectomy modifies calcified plaque, facilitating stent delivery and optimizing stent expansion. There are no data on these patients who present with NSTEMI who undergo orbital atherectomy. Methods Of the 454 consecutive real-world patients who underwent orbital atherectomy in our retrospective multicenter registry, 51 patients (11.2%) presented with NSTEMI. The primary safety endpoint was the rate of major adverse cardiac and cerebrovascular events (MACCE) at 30 days. Results Patients with NSTEMI had a higher prevalence of chronic kidney disease, lower mean ejection fraction, and required more vessels to be treated. The primary endpoint was similar in patients who presented with and without NSTEMI (2.0% vs. 2.2%, p  = 0.9), as were the 30-day rates of death (2.0% vs. 1.2%, p  = 0.67), MI (0% vs. 1.2%, p  = 0.42), target vessel revascularization (0% vs. 0%, p  > 0.91), and stroke (0% vs. 0.2%, p  = 0.72). The rates of angiographic complications and stent thrombosis rate were low in both groups. Conclusions Despite having worse baseline characteristics, patients who presented with NSTEMI and subsequently underwent orbital atherectomy had similar clinical outcomes compared with patients without NSTEMI.