***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 infa rct ion ( 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 , prospect i ve studies are needed to confirm our findings OBJECTIVES This study sought to determine the frequency and impact of coronary calcification among patients undergoing percutaneous coronary intervention ( PCI ) for acute coronary syndromes ( ACS ) . BACKGROUND Small studies in patients with stable coronary artery disease have suggested a worse prognosis after PCI of calcified compared with noncalcified lesions . Little is known about the impact of coronary calcification on outcomes after PCI for patients presenting with non-ST-segment elevation and ST-segment elevation ACS . METHODS Data from 6,855 patients presenting with ACS in whom PCI was performed were pooled from 2 large-scale r and omized , controlled trials , ACUITY ( Acute Catheterization and Urgent Intervention Triage Strategy ) and HORIZONS-AMI ( Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infa rct ion ) . One-year outcomes were analyzed according to the severity of PCI target lesion calcification ( none/mild , moderate , or severe ) as assessed by an independent angiographic core laboratory . RESULTS Target lesion calcification was severe in 402 patients ( 5.9 % ) , moderate in 1,788 ( 26.1 % ) , and none/mild in 4,665 ( 68.1 % ) . Moderate/severe target lesion calcification was more frequent in older patients , men , hypertensive patients , and those presenting with ST-segment elevation myocardial infa rct ion ( STEMI ) . The unadjusted 1-year rates of death , cardiac death , definite stent thrombosis , and ischemic target lesion revascularization ( TLR ) and target vessel revascularization were significantly increased in patients with moderate/severe target lesion calcification . By multivariable analysis , the presence of moderate/severe target lesion calcification was an independent predictor of 1-year definite stent thrombosis ( hazard ratio [ HR ] : 1.62 ; 95 % confidence interval [ CI ] : 1.14 to 2.30 ; p = 0.007 ) and ischemic TLR ( HR : 1.44 ; 95 % CI : 1.17 to 1.78 ; p = 0.0007 ) . CONCLUSIONS Moderate/severe lesion calcification was relatively frequent in patients with non-ST-segment elevation ACS and STEMI and was strongly predictive of stent thrombosis and ischemic TLR at 1 year . ( Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ ACS ] ; NCT00093158 ; Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infa rct ion ; NCT00433966 ) Objective To investigate the long-term prognostic implication s of coronary calcification in patients undergoing percutaneous coronary intervention for obstructive coronary artery disease . Methods Patient-level data from 6296 patients enrolled in seven clinical drug-eluting stents trials were analysed to identify in angiographic images the presence of severe coronary calcification by an independent academic research organisation ( Cardialysis , Rotterdam , The Netherl and s ) . Clinical outcomes at 3-years follow-up including all-cause mortality , death — myocardial infa rct ion ( MI ) , and the composite end-point of all-cause death — MI — any revascularisation were compared between patients with and without severe calcification . Results Severe calcification was detected in 20 % of the studied population . Patients with severe lesion calcification were less likely to have undergone complete revascularisation ( 48 % vs 55.6 % , p<0.001 ) and had an increased mortality compared with those without severely calcified arteries ( 10.8 % vs 4.4 % , p<0.001 ) . The event rate was also high in patients with severely calcified lesions for the combined end-point death — MI ( 22.9 % vs 10.9 % ; p<0.001 ) and death — MI— any revascularisation ( 31.8 % vs 22.4 % ; p<0.001 ) . On multivariate Cox regression analysis , including the Syntax score , the presence of severe coronary calcification was an independent predictor of poor prognosis ( HR : 1.33 95 % CI 1.00 to 1.77 , p=0.047 for death ; 1.23 , 95 % CI 1.02 to 1.49 , p=0.031 for death — MI , and 1.18 , 95 % CI 1.01 to 1.39 , p=0.042 for death — MI— any revascularisation ) , but it was not associated with an increased risk of stent thrombosis . Conclusions Patients with severely calcified lesions have worse clinical outcomes compared to those without severe coronary calcification . Severe coronary calcification appears as an independent predictor of worse prognosis , and should be considered as a marker of advanced atherosclerosis BACKGROUND Because of the challenges in treating calcified coronary artery disease ( CAD ) , lesion preparation has become increasingly important prior to percutaneous coronary intervention ( PCI ) . Despite growing data for both rotational atherectomy ( RA ) and orbital atherectomy ( OA ) , there have been no multicenter studies comparing the safety and efficacy of both . We sought to examine the clinical outcomes of patients with calcified CAD who underwent atherectomy .  METHODS A total of 39 870 patients from five tertiary care hospitals who had PCI from January 2011 to January 2017 were identified . 907 patients who had RA or OA were included . This multicenter , prospect ively collected observational analysis compared OA and RA . The primary end-point was myocardial infa rct ion and safety outcomes including significant dissection , perforation , cardiac tamponade , and vascular complications . Propensity score matching ( 1:1 ) was performed to reduce selection bias . RESULTS After matching , 546 patients were included in the final analysis . The primary endpoint , myocardial infa rct ion occurred less frequently with OA compared to RA ( 6.7 % vs 13.8 % , P ≤ 0.01 ) in propensity score matched cohorts . Procedural safety outcomes were comparable between the groups . The secondary outcome of death on discharge occurred less in the OA group as compared with RA ( 0 % vs 2.2 % , P = 0.01 ) . Fluoroscopy time was less in patients who were treated with OA ( 21.9 vs 25.6 min , P ≤ 0.01 ) . Additional secondary outcomes were comparable between groups . CONCLUSION In this non-r and omized , multicenter comparison of contemporary atherectomy devices , OA was associated with significantly decreased in-hospital myocardial infa rct ion and mortality after propensity score matching with decreased fluoroscopy time OBJECTIVES The ORBIT II ( Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions ) trial evaluated the safety and efficacy of the coronary Orbital Atherectomy System ( OAS ) to prepare de novo , severely calcified coronary lesions for stent placement . BACKGROUND Despite advances in interventional techniques , treatment of calcified coronary lesions remains a challenge . Stent placement in these lesions may result in stent underexpansion , malapposition , and procedural complications . METHODS ORBIT II is a prospect i ve , multicenter , nonblinded clinical trial that enrolled 443 consecutive patients with severely calcified coronary lesions at 49 U.S. sites from May 25 , 2010 , to November 26 , 2012 . Investigators used the centrifugal action of the OAS diamond-coated crown to modify calcified lesions prior to stent placement . RESULTS The pre-procedure mean minimal lumen diameter of 0.5 mm increased to 2.9 mm after the procedure . The primary safety endpoint was 89.6 % freedom from 30-day major adverse cardiac events compared with the performance goal of 83 % . The primary efficacy endpoint ( residual stenosis < 50 % post-stent without in-hospital major adverse cardiac events ) was 88.9 % compared with the performance goal of 82 % . Stent delivery occurred successfully in 97.7 % of cases with < 50 % stenosis in 98.6 % of subjects . Low rates of in-hospital Q-wave myocardial infa rct ion ( 0.7 % ) , cardiac death ( 0.2 % ) , and target vessel revascularization ( 0.7 % ) were reported . CONCLUSIONS The ORBIT II coronary OAS trial met both the primary safety and efficacy endpoints by significant margins . Preparation of severely calcified plaque with the OAS not only helped facilitate stent delivery , but improved both acute and 30-day clinical outcomes compared with the outcomes of historic control subjects in this difficult-to-treat patient population . ( Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions [ ORBIT II ] ; NCT01092416 ) BACKGROUND Treatment of calcified ( in contrast to simple ) lesions with PTCA has been associated with a lower success rate and more procedural complications . Rotablation can improve acute results , but the high restenosis rate remains a problem . The purpose of this study was to evaluate the clinical and angiographic outcome of patients with complex and calcified lesions treated with a combination of rotablation and stenting .  METHODS AND RESULTS Seventy-five consecutive patients with 106 lesions had rotablation prior to coronary stenting . Intravascular ultrasound-guided stenting was used without subsequent anticoagulation in 93 % of patients . Procedural success was achieved in 93.4 % of lesions . Acute stent thrombosis occurred in two lesions ( 1.9 % ) , and subacute stent thrombosis in one lesion ( 0.9 % ) . Angiographic follow-up was performed in 82.5 % of lesions at 4.6 + /- 1.9 months with an angiographic restenosis rate of 22.5 % . Clinical follow-up was performed in all patients at 6.4 + /- 3 months ; target lesion revascularization was needed in 18 % of lesions ; Q-wave myocardial infa rct ion occurred in 1.3 % , coronary bypass surgery in 4.0 % , and death in 1.3 % . CONCLUSIONS Optimal coronary stenting after rotablation in calcified and complex lesions can be performed with a high success rate , an acceptable rate of procedural complications , and a low rate of stent thrombosis . This approach was associated with a low incidence of angiographic restenosis compared with results usually obtained with other interventional strategies in calcified and complex lesion subsets OBJECTIVES This study sought to determine the effect of rotational atherectomy ( RA ) on drug-eluting stent ( DES ) effectiveness . BACKGROUND DES are frequently used in complex lesions , including calcified stenoses , which may challenge DES delivery , expansion , and effectiveness . RA can adequately modify calcified plaques and facilitate stent delivery and expansion . Its impact on DES effectiveness is widely unknown . METHODS The ROTAXUS ( Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease ) study r and omly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting ( n = 120 ) or stenting without RA ( n = 120 , st and ard therapy group ) .  Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent . The primary endpoint was in-stent late lumen loss at 9 months . Secondary endpoints included angiographic and strategy success , binary restenosis , definite stent thrombosis , and major adverse cardiac events at 9 months . R 
    Output:
    
CONCLUSION Except for lower fluoroscopy time with OA , there are no significant differences between OA and RA in relation to procedural , periprocedural , and thirty day outcomes among patients with calcified CAD undergoing PCI