Coronary orbital atherectomy treatment of Hispanic and Latino patients: A real‐world comparative analysis

Abstract

Objectives: To assess coronary orbital atherectomy (OA) use in Hispanic or Latino (HL) patients compared to non-HL patients.Background: HL patients are at greater risk of cardiovascular disease mortality compared with Whites with similar coronary artery calcium (CAC) scores. The safety and efficacy of coronary atherectomy in the HL patient population is unknown due to the under-representation of minorities in clinical trial research.Methods: A retrospective analysis of consecutive patients undergoing coronary OA treatment of severely calcified lesions at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB) was completed. From January 2014 to September 2020, a total of 609 patients from MSMCMB who underwent percutaneous coronary intervention with OA were identified in the electronic health records.Results: Of those identified, 350 (57.5%) had an ethnicity classification of HL. The overall mean age was 74 years and there was a high prevalence of diabetes in the HL group compared to the non-HL group (49.7% vs. 34.7%; p = 0.0003). Severe angiographic complications were uncommon and in-hospital freedom from major adverse cardiac events (MACE), a composite of cardiac death, MI, and stroke (ischemic or hemorrhagic cerebrovascular accidents), was 98.5% overall, with no significant difference between the HL and non-HL groups, despite the higher prevalence of diabetes in the HL group.Conclusions: This study represents the largest real-world experience of OA use in HL versus non-HL patients. The main finding in this retrospective analysis is that OA can be performed safely and effectively in a high-risk population of HL patients.

Systematic Review of the Efficacy of Orbital Atherectomy in Improving the Outcome of Percutaneous Corornary Intervention in People With Diabetes

“…Of the 321 references retrieved initially from the databases, only eighteen quantitative studies were selected for final analysis [9,13,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]. Twelve studies were retrospective [9,[39][40][41][42][43][45][46][47][48][49][50] while six are prospective [13,44,[51][52][53][54]. Six studies are non-randomized clinical trials (subanalysis and follow-ups of ORBIT 1 and 11 trials) [13,44,[51][52][53][54].…”

“…Six studies are non-randomized clinical trials (subanalysis and follow-ups of ORBIT 1 and 11 trials) [13,44,[51][52][53][54]. Ten are multicenter studies [9,13,39,40,[44][45][46][47]50,54] while the rest are single-centred [41][42][43]48,49,52]. The included studies were all conducted in the USA [9,13,39-51], except three which were conducted in India [52][53][54].…”

“…There is a higher prevalence of hypertension (HTN), CKD, hyperlipidemia (HLD), stroke, MI, prior CABG, and PCI in the DM group in most of the studies (see Table 1). Eight studies had smaller cohorts [39][40][41]48,49,[52][53][54], while the follow-up duration was noticeably short in seven studies [9,40,41,43,45,49,50].…”

“…FIGURE 1: Effect direction plot[9,13,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] …”