In-Hospital Outcomes of Intravascular Lithotripsy compared to Rotational Atherectomy and Cutting / Scoring Balloon Angioplasty

M. C. Gissler (Freiburg im Breisgau)¹, K. Kaier (Freiburg im Breisgau)², F. Rahimi Nedjat (Bad Krozingen)³, D. Wolf (Freiburg im Breisgau)¹, M. Ferenc (Bad Krozingen)⁴, D. Westermann (Freiburg im Breisgau)⁵, Z. Ali (Roslyn)⁶, C. von zur Mühlen (Freiburg im Breisgau)⁷, A. Maier (Freiburg im Breisgau)^1
1Universitäts-Herzzentrum Freiburg - Bad Krozingen Klinik für Kardiologie und Angiologie Freiburg im Breisgau, Deutschland; ²Universitätsklinikum Freiburg Institut für Medizinische Biometrie und Statistik Freiburg im Breisgau, Deutschland; ³Universitäts-Herzzentrum Freiburg / Bad Krozingen Bad Krozingen, Deutschland; ⁴Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie II Bad Krozingen, Deutschland; ⁵Universitäts-Herzzentrum Freiburg - Bad Krozingen Innere Medizin III, Kardiologie und Angiologie Freiburg im Breisgau, Deutschland; ⁶St. Francis Hospital Roslyn, USA; ⁷Albert- Ludwigs-Universität Freiburg Innere Medizin III, Kardiologie und Angiologie Freiburg im Breisgau, Deutschland

Background

Intravascular lithotripsy (IVL) emerged for the treatment of coronary artery calcification with encouraging safety and effectiveness rates in previous trials. Knowledge about in-hospital safety of IVL in comparison to frequently used plaque modification techniques remains limited.

 

Objectives

The aim of this study was to assess 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 while allowing for a more timely discharge of patients.