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Competing Interests: Declaration of competing interest Dr. Spirito reports a relation with Swiss National Science Foundation that includes funding grants. Dr. Mehran reports a relation with Abbott Vascular Inc that includes funding grants; a relation with AstraZeneca that includes funding grants; and a relation with the Society for Cardiovascular Angiography and Interventions that includes funding grants. The remaining authors have no competing interests to declare.

Objectives: To compare clinical and safety endpoints with use of rotational (RA) and orbital (OA) atherectomy in a large patient population with moderate to severely calcified lesions undergoing percutaneous coronary intervention (PCI).Background: Coronary artery calcification (CAC) has been recognized as a risk factor for adverse outcomes with coronary artery disease (CAD). Though atheroablative techniques, RA and OA have been used extensively, comparison of their clinical and safety endpoints is lacking. Comparison of these two modalities formed the basis of our study.Methods and Results: Of 12 001 patients who underwent PCI at our institution between January 2013-December 2015, we studied 998 consecutive patients with severe calcification treated with atheroablation. We assessed clinical outcomes including death, myocardial infarction (MI) and target lesion revascularization (TLR) at 30 days and 6 months in addition to post-procedural complications. Device perforation occurred more frequently with use of OA at high burr speed versus RA (1.9%, n = 3 vs. 0.2%, n = 2, P = 0.03). Rates of composite adverse events were similar between groups at 6 months (18.55 vs. 11.46%; P = 0.11) CONCLUSION: In this retrospective, single center study, we observed no significant differences in 6-month rates of adverse events associated with use of OA vs. RA in patients with moderate to severe calcification undergoing PCI. Larger, prospective studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]