Safety and Efficacy of Intravascular Lithotripsy in Calcified Left Main Coronary Artery Disease: A Systematic Review and Meta-Analysis.

BACKGROUND

Intravascular lithotripsy (IVL) has emerged as a novel therapeutic modality for the management of calcified coronary lesions. The effectiveness and safety of IVL specifically in the context of left main disease remains uncertain and limited. We performed a meta-analysis to consolidate existing data.

METHODS

Online databases Medline, Embase, Cochrane were searched for studies using IVL during percutaneous coronary intervention (PCI) of calcified left main disease. The outcomes of interest were procedural success, procedural complications and cardiovascular (CV) events. Pooled proportions with 95% confidence intervals (CI) were calculated using a random-effects model.

RESULTS

A total of 10 studies with 435 patients (mean age 73.1 years, 73.1% males) were included. The pooled outcomes were procedural success 98.8% (95% CI 95.58-100), perforation 0.02% (95% CI 0.00-0.87), major dissection 0.87% (95% CI 0.00-3.97), slow-flow/no-reflow 0.27% (95% CI 0.00-1.47) and abrupt vessel closure 0.01% (95% CI 0.00-1.01). In-hospital CV events were major adverse CV events (MACE) 2.14% (95% CI 0.64-4.21), death 0.96% (95% CI 0.00-2.98), CV death 0.46% (95% CI 0.00-2.17), myocardial infarction (MI) 0.94% (95% CI 0.04-2.56), stent thrombosis 0.99% (95% CI 0.00-6.14) and target vessel revascularization 0% (95% CI 0.00-0.32). Thirty-day outcomes were MACE 4.79% (95% CI 1.51-9.35), mortality 3.09% (95% CI 0.00-9.69) and MI 2.25% (95% CI 0.45-4.95).

CONCLUSIONS

Use of IVL during PCI of calcified left main disease is associated with a favorable procedural rates of success, with low risk of procedural complications and ischemic events.