Comparison of rotational with orbital atherectomy during percutaneous coronary intervention for coronary artery calcification: A systematic review and meta-analysis Abhishek C. Sawant a , Hemang Panchal b , Dhruvil Radadiya c , Alexander Pomakov d , Gary Tse e , Tong Liu f , Srilekha Sridhara a , Janelle Rodriguez a , Meghana Prakash Hiriyur Prakash a , Nidhi Kanwar d , Arnav Kumar g , Kinjal Banerjee h , Philipp Wiesner a , Ashish Pershad a, ⁎ a Division of Interventional Cardiology, Banner University Medical Center, Phoenix, AZ, USA b Division of Cardiology Mount Sinai Medical Center, Columbia University, Miami Beach, FL, USA c Department of Medicine, East Tennessee State University, Johnson City, TN, USA d Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA e Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region f Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China g Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, USA h Department of Medicine, Geisinger Commonwealth School of Medicine, Geisinger, PA, USA abstract article info Article history: Received 25 March 2019 Received in revised form 29 June 2019 Accepted 17 July 2019 Available online xxxx Background: Percutaneous coronary intervention (PCI) outcomes for patients with significant calcification have been consistently inferior compared to patients without significant calcification. Procedural success and long- term outcomes after PCI have been worse in patients with severe coronary calcium. Objective: A Bayesian meta-analysis of outcomes comparing rotational atherectomy (RA) with orbital atherec- tomy (OA) was performed. Methods: PubMed, Embase, and Cochrane Library databases were searched through 30th November 2018 and identified 4 observational studies. Results: The primary end-point, Major Adverse Cardiac Event (MACE) composing of death, MI and stroke at 1 year was more likely with RA (OR = 1.61; 95% CI: 1.11–2.33; p = 0.01) as compared to OA. The driver of the difference in MACE between the two groups was a statistically significant difference in mortality favoring OA (OR = 4.65; 95% CI: 1.36–15.87; p = 0.01). Peri-procedural MI, the other component of the primary end-point was 1.3 times more likely in the RA arm (OR = 1.35; 95% CI 0.95–1.92; p-0.09) and was not statistically different between the groups. The odds of a vascular complication were not different in the two groups (OR = 1.26; 95% CI: 0.73–2.17; p = 0.41). In an adjusted Bayesian analysis, mortality (OR = 3.69; 95% CI: 0.30–38.51), MACE (OR = 1.68; 95% CI: 0.55– 5.49), MI (OR = 1.42; 95% CI: 0.50–4.29) and dissections/perforations (OR = 0.38; 95% CI: 0.10–1.38) were not different in RA and OA groups. Conclusion: Our study is the first published Bayesian meta-analysis comparing MACE and peri-procedural out- comes in RA compared to OA. These findings lay the foundation for a randomized comparison between the two competing technologies. © 2019 Elsevier Inc. All rights reserved. Keywords: Atherectomy Meta-analysis Percutaneous Coronary Intervention 1. Introduction Even in the contemporary drug eluting stent era, coronary calcium continues to present a significant challenge [1]. Outcomes of percutane- ous coronary intervention (PCI) in patients with significant coronary calcification have been inferior when compared to patients without sig- nificant calcification [2–4]. At this time, there are two devices that are U.S. Food and Drug Administration (FDA) approved to treat coronary calcification- (1) Rotational Atherectomy (RA) and (2) Orbital Atherec- tomy (OA). The Rotablator (Boston Scientific, Marlborough, Cardiovascular Revascularization Medicine xxx (xxxx) xxx Abbreviations: PCI, Percutaneous Coronary Intervention; FDA, Food and Drug Administration; RA, Rotational Atherectomy; OA, Orbital Atherectomy; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; MACE, Major Adverse Cardiac Events; MI, Myocardial Infarction. ⁎ Corresponding author at: Department of Cardiology, University of Arizona School of Medicine – Phoenix, Banner University Medical Center- Phoenix, 750 E. McDowell Road, Phoenix, AZ 85006, USA. E-mail address: ashish.pershad@bannerhealth.com (A. Pershad). CARREV-01653; No of Pages 7 https://doi.org/10.1016/j.carrev.2019.07.019 1553-8389/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Cardiovascular Revascularization Medicine Please cite this article as: A.C. Sawant, H. Panchal, D. Radadiya, et al., Comparison of rotational with orbital atherectomy during percutaneous coronary intervention for coro..., Cardiovascular Revascularization Medicine, https://doi.org/10.1016/j.carrev.2019.07.019