Myocardial Injury After Orbital Atherectomy and the Association with Coronary Lesion Length

Jakob Ledwoch (München)1, P. Styllou (München)1, V. Klauss (München)2, M. Leibig (Heimstetten)3, E. Luciani (München)4, I. S. Koutsouraki (München)1, C. Freymüller (München)1, A. Leber (München)1

1Isarkliniken GmbH Klinik für Kardiologie und internistische Intensivmedizin München, Deutschland; 2Kardiologie - Innenstadt München, Deutschland; 3Internistisches Zentrum Heimstetten Heimstetten, Deutschland; 4Herz im Zentrum Innere Medizin - Kardiologie München, Deutschland


Background: Limited data are available regarding myocardial injury and its risk factors in percutaneous coronary interventions (PCI) of severe calcified lesions using orbital atherectomy (OA). 

Methods: Patients who underwent OA at our institution were retrospectively enrolled into the present single-center registry. High-sensitive Troponin I (hsTroponin I), EKG and echocardiography were used to assess myocardial injury after the procedure. For the evaluation of risk factors for myocardial injury two groups were created dependent on the hsTroponin I median.

Results: A total of 27 patients who underwent OA between January 2022 and June 2023 were included. Median lesion length of the overall population was 42 (20-50) mm, and most lesions were complex (AHA/ACC class B2/C in 93% of the cases). Procedural success was achieved in all patients. Myocardial injury (elevation of hsTroponin I above the 99th percentile upper reference limit) occurred in all patients. Median hsTroponin I on the first day after the procedure was 1093 (557-4037) ng/l with a minimum of 86ng/l and a maximum of 25756ng/l. Myocardial infarction occurred in two patients (7%), who had severe coronary dissection after OA. In patients with increased hsTroponin I levels above the median lesions were significantly longer (47 [38-52] mm vs. 20 [14-47] mm; p=0.009) compared to those with hsTroponin I levels below the median. Furthermore, a moderate correlation between hsTroponin I and lesion length was detected (r=0.54; p=0.004). In most patients, neither relevant CK and CK-MB elevation nor wall motion abnormalities were detected even in those subjects with very high hsTroponin I after the procedure.

Conclusions: In the present study myocardial injury occurred in all patients after OA without loss of viable myocardium in the majority of patients. Lesions length was found to be a significant factor associated with markedly increased hsTroponin I after the OA procedure. The impact of increased hsTroponin I

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