Incidence of periprocedural myocardial injury and clinical outcomes after rotational atherectomy vs. intravascular lithotripsy.

BACKGROUND

Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are established plaque-modifying strategies for heavily calcified coronary lesions. Despite their different mechanisms, the incidence of significant periprocedural myocardial injury (PMI) and its clinical implications remain inadequately studied. This study compared the incidence of significant PMI and clinical outcomes following PCI with IVL versus RA.

METHODS

We retrospectively analyzed 422 lesions (RA: 332; IVL: 90) in 398 patients who underwent PCI for moderately or severely calcified lesions between November 2019 and June 2024. High-sensitivity cardiac troponin (hs-cTn) was systematically measured after PCI. Significant PMI was defined according to the Academic Research Consortium-2 (ARC-2) criteria as post-PCI hs-cTn ≥70× the upper reference limit. The two-year incidence of target lesion failure (TLF)-a composite of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization-was assessed.

RESULTS

Significant PMI (hs-cTn ≥70× URL) occurred in 25% of RA-treated lesions and 18% of IVL-treated lesions (P = 0.15). Median peak hs-cTn levels were higher after RA than after IVL (27.6 [10.7-70.9] vs. 17.7 [6.3-51.2] × URL; P = 0.024), but the difference was not significant after propensity score matching (21.3 [9.1-59.7] vs. 17.7 [6.3-51.2] × URL; P = 0.35). The two-year incidence of TLF was also similar between the two groups (RA: 9% vs. IVL: 11%; adjusted hazard ratio: 1.82; 95% CI 0.76-4.37; P = 0.17).

CONCLUSION

Significant PMI was frequently observed after PCI for heavily calcified lesions treated with either IVL or RA, and the two-year TLF rates did not significantly differ between the two methods.