Clinical research in cardiology : official journal of the German Cardiac Society · 2026
In-hospital outcomes of intravascular lithotripsy compared to rotational atherectomy and cutting/scoring balloon angioplasty.
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Gissler Mark Colin, Kaier Klaus, Rahimi Faridun, Bacmeister Lucas, Rilinger Jonathan, Heger Lukas A, Jäckel Markus, Bojti István, Marchini Timoteo, Wolf Dennis, Ferenc Miroslaw, Westermann Dirk, Ali Ziad A, von Zur Mühlen Constantin, Maier Alexander
Аннотация
BACKGROUND: Intravascular lithotripsy (IVL) emerged for the treatment of coronary artery calcification with encouraging safety and effectiveness rates in previous trials. Knowledge about the in-hospital safety of IVL in comparison to frequently used plaque modification techniques remains limited.
OBJECTIVES: The aim of this study was to assess the in-hospital outcomes of IVL in comparison to rotational atherectomy (RA) and cutting/scoring balloons (C/S).
METHODS: A total of 51,921 isolated PCI procedures of patients who underwent planned coronary angiography with IVL, RA or C/S between 2019 and 2023 were extracted from a German nationwide registry. Analyses of the average treatment effect were carried out employing a double-robust estimator using machine learning algorithms.
RESULTS: Compared to IVL, adjusted procedural relative risk of in-hospital mortality was significantly higher for RA (RR 1.72; 95% CI: 1.24 - 2.38, p = 0.001) and C/S (RR 1.50; 95% CI: 1.08 - 2.08, p = 0.015), while safety parameters such as stroke, severe bleeding and acute kidney injury were comparable. The adjusted risk of shock (RR 1.57; 95% CI: 1.20 - 2.04, p = 0.001) and pericardial drainage (RR 1.95; 95% CI: 1.23 - 3.07, p = 0.004) was lower for IVL compared to RA but not to C/S. Further, IVL use was associated with a shorter adjusted length of hospitalization compared to RA (- 0.75 days, p < 0.001) and C/S (- 0.22 days, p = 0.047).
CONCLUSION: IVL is associated with a favorable safety profile compared to RA and C/S and a more timely discharge of patients.
OBJECTIVES: The aim of this study was to assess the in-hospital outcomes of IVL in comparison to rotational atherectomy (RA) and cutting/scoring balloons (C/S).
METHODS: A total of 51,921 isolated PCI procedures of patients who underwent planned coronary angiography with IVL, RA or C/S between 2019 and 2023 were extracted from a German nationwide registry. Analyses of the average treatment effect were carried out employing a double-robust estimator using machine learning algorithms.
RESULTS: Compared to IVL, adjusted procedural relative risk of in-hospital mortality was significantly higher for RA (RR 1.72; 95% CI: 1.24 - 2.38, p = 0.001) and C/S (RR 1.50; 95% CI: 1.08 - 2.08, p = 0.015), while safety parameters such as stroke, severe bleeding and acute kidney injury were comparable. The adjusted risk of shock (RR 1.57; 95% CI: 1.20 - 2.04, p = 0.001) and pericardial drainage (RR 1.95; 95% CI: 1.23 - 3.07, p = 0.004) was lower for IVL compared to RA but not to C/S. Further, IVL use was associated with a shorter adjusted length of hospitalization compared to RA (- 0.75 days, p < 0.001) and C/S (- 0.22 days, p = 0.047).
CONCLUSION: IVL is associated with a favorable safety profile compared to RA and C/S and a more timely discharge of patients.