Meta-Analysis of Rotational Atherectomy versus Modified Balloons for the Treatment of De Novo Calcified Coronary Lesions

Anugu, Viswajit Reddy

Meta-Analysis of Rotational Atherectomy versus Modified Balloons for the Treatment of De Novo Calcified Coronary Lesions

Wednesday, May 22, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Viswajit Reddy Anugu , Staten Island University Hospital , Staten Island, NY

Nikhil Nalluri , Lenox Hill Hospital, New York, NY

Karthik Seetharam , Zucker School of Medicine at Hofstra/Northwell-Lenox Hill Hospital

Varunsiri Atti , Michigan State University, Lansing, MI

Bhavi Pandya , Staten Island University Hospital , Staten Island, NY

Srikanth Yandrapalli , WESTCHESTER MEDICAL CENTER/NEW YORK MEDICAL COLLEGE, VALHALLA, NY, Valhalla, NY

James Lafferty , Staten Island University Hospital, Staten Island, NY

Roman Y. Royzman , Staten Island University Hospital, Brooklyn, NY

Frank Tamburrino , Staten Island University Hospital, Staten Island, NY

Ruben Kandov , Staten Island University Hospital, Staten Island, NY

Background
Intervention of calcified coronary lesions is quite challenging and mechanical plaque modification techniques such as rotational atherectomy (RA) and modified (cutting or scoring) balloons (MB) are helpful in lesion preparation prior to stenting. We performed a meta-analysis comparing RA with MB in treating calcified coronary lesions.

Methods
PubMed, EMBASE, Google Scholar databases and conference presentations were searched for studies comparing RA with MB. We performed a meta-analysis and compared all-cause mortality, myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR) and target vessel failure (TVF).

Results
Total number of patients in our study was 1389 from 3 studies (1 randomized and 2 observational studies) with 663 patents in RA group and 726 patients in MB group. Mean follow up period was 11 months. The mean age of RA patients is 72.2± 2.4 years and mean age of MB patients is 69.6± 4.8 years (P= 0.4404). The mean lesion length in RA group is 30.7± 10.3 mm and mean lesion length in MB is 25± 5.6 mm (P= 0.4484). There was no statistically significant difference between RA and MB in MI (RR 0.73, 95% CI 0.42-1.27; P= 0.26), ST (RR 1.66, 95% CI 0.56- 4.93, P=0.36), TLR (RR 0.76, 95%CI 0.52-1.11, P= 0.15), TVR (RR 0.87, 95% CI 0.43- 1.79, P= 0.71) and TVF (RR 0.86, 95% CI 0.52- 1.44, P= 0.57). RA was associated with overall higher all-cause mortality (RR 1.55, 95% CI 1.13- 2.13, P= 0.007).

Conclusions
RA was associated with a higher all-cause mortality when compared to MB. There was no significant difference in MI, ST, TLR, TVR and TVF between the two groups.