Real-World Outcome of Coronary Orbital Atherectomy in Diabetic Versus Non-Diabetic Patients: A Single-Center Experience.

Background and aims: Clinical trial research on the safety and efficacy of coronary orbital atherectomy (OA) in diabetics compared to non-diabetics is limited. This single-center study aimed to perform a diabetic comparative analysis using real-world data.

Methods: A retrospective analysis was conducted on consecutive patients undergoing coronary OA treatment for severely calcified lesions at Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB), from January 2014 to September 2020. Severe angiographic complications, bleeding complications, in-hospital heart failure and cardiogenic shock were reviewed. Major adverse cardiac and cerebrovascular events (MACCE), including cardiac death, MI, and cerebrovascular accident (CVA) were assessed in-hospital and at 1- and 2-year follow-up.

Results: A total of 609 patients who underwent percutaneous coronary intervention with OA were identified. Among them, 43% were diabetic with a median age of 75 for both cohorts. In the diabetic cohort, there was a higher prevalence of Hispanics (66% vs. 51%; p < 0.001), dyslipidemia (81% vs. 72%; p = 0.005), and hypertension (94% vs. 89%; p = 0.033). There were no significant differences between the two groups in terms of severe angiographic complications, bleeding complications, in-hospital MACCE or MACCE at 1- and 2-year follow-ups.

Conclusions: This real-world comparative analysis suggests that coronary OA is a safe and effective plaque modification technique in diabetic patients with severely calcified coronary artery disease, with outcomes comparable to those of non-diabetics.