P23 Comparing rotational and orbital atherectomy for the treatment of calcified coronary lesions: an updated systematic review and meta-analysis
Bibliographic record
Abstract
<h3>Introduction</h3> Coronary artery calcification (CAC) is associated with poor outcomes in patients undergoing percutaneous coronary intervention (PCI).<sup>1</sup>Rotational atherectomy (RA) and orbital atherectomy (OA) are two ways to manage CAC.<sup>2</sup> <h3>Methods</h3> A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed was searched from January 2000 to July 2025. Eligible studies reported comparisons between OA and RA in the management of patients with severe CAC. Data was synthesised quantitatively and narratively. The Newcastle-Ottawa scale was used to assess risk of bias in observational studies, and the Cochrane Risk of Bias Tool was used for randomised controlled trials. <h3>Results</h3> No significant differences were found in short-term major adverse cardiovascular events (MACE), cardiac mortality, long-term non-fatal myocardial infarction (MI), or short-term target vessel revascularisation (TVR). RA was associated with higher long-term MACE (OR: 1.52, 95% CI: 1.02–2.27), long-term TVR (OR: 2.55, 95% CI: 1.14–5.71), short-term non-fatal MI (OR: 1.75, 95% CI: 1.05–2.92), and short- and long-term all-cause mortality (OR: 1.61 and 3.98, respectively). However, RA showed lower rates of coronary dissection (OR: 0.36, 95% CI: 0.29–0.45) and cardiac tamponade (OR: 0.34, 95% CI: 0.25–0.46). No differences were found in slow-flow/no-reflow, device-induced perforation, fluoroscopy time, or contrast volume. <h3>Conclusion</h3> OA is associated with superior long-term outcomes, while RA demonstrated fewer procedural complications, highlighting the need for individualised device selection based on patient and lesion characteristics. <h3>References</h3> Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. <i>J Am Coll Cardiol.</i> 2006;<b>47</b>(8 Suppl):C13-C18. Khan MH, Ahmed Z, Fatima B, <i>et al</i>. Rotational versus orbital atherectomy for treating heavily calcified coronary lesions: a meta-analysis. <i>Catheter Cardiovasc Interv.</i> 2020;<b>96</b>(6):1242–1249.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".