In-hospital outcomes of intravascular lithotripsy compared to rotational atherectomy and cutting/scoring balloon angioplasty.

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.