Background: Data comparing rotational atherectomy (RA) with orbital atherectomy (OA) for calcified lesions is inconclusive and based on single observational studies in populations with limited numbers of patients.

Aims: The aim of the study was to perform a meta‑analysis of observational studies comparing RA with OA for calcified lesions prior to percutaneous coronary intervention.

Methods: Electronic databases were searched for studies comparing short‑term outcomes of RA with OA prior to percutaneous coronary intervention. Risk ratios (RRs) or mean differences (MD) and 95% confidence intervals (CIs) were calculated using a random‑effects model.

Results: Meta‑analysis included 6 retrospective studies with 1590 patients treated with RA and 721 with OA. The latter was associated with shorter fluoroscopy time (MD,–3.40 min; 95% CI,–4.76 to–2.04; P< 0.001, I2= 0%), but contrast use was similar (MD,–2.78 ml; 95% CI,–16.04 to 10.47; P= 0.68; I2= 67%). Although coronary dissection occurred 4‑fold more frequently with OA (RR, 3.87; 95% CI, 1.37–10.93; P= 0.01; I2= 0%), perforations (RR, 2.73; 95% CI, 0.46–16.30, P= 0.27; I2= 41), tamponade (RR, 1.78; 95% CI, 0.37–8.58; P= 0.47; I2= 0%), and slow or no‑reflow phenomenon (RR, 0.81; 95% CI, 0.35–1.84; P= 0.61; I2= 0%) occurred with similar frequency. The risk of 30‑day or in‑hospital myocardial infarction was lower in OA as compared with RA (RR, 0.67; 95% CI, 0.47–0.94; P= 0.02; I2= 0%), yet the risk of in‑hospital mortality (RR, 0.73; 95% CI, 0.11–4.64; P= 0.74; I2= 43%) and length of stay (MD,–0.27 days; 95% CI,–0.76 to–0.23; P= 0.29; I2= 0%) did not differ.

Conclusions: Orbital atherectomy was associated with a lower risk of early myocardial infarction. However, a higher rate of coronary dissections produced by OA did not translate into increased risk of perforations, slow or no‑reflow phenomenon, or in‑hospital mortality.