Outcomes of coronary intravascular lithotripsy for the treatment of calcified nodules: a pooled analysis of the Disrupt CAD studies
Ziad A. Ali, Doosup Shin, Mandeep Singh, Sarah Malik, Koshiro Sakai, Benjamin Honton, Dean J. Kereiakes, Jonathan Hill, Shigeru Saito, Carlo Di Mario, Nieves Gonzalo, Robert F. Riley, Akiko Maehara, Mitsuaki Matsumura, Jason Y Hokama, Nick E.J. West, Gregg W. Stone, Richard Shlofmitz
Abstract
BACKGROUND: Coronary intravascular lithotripsy (IVL) safely facilitates stent implantation in severely calcified lesions. AIMS: This analysis sought to determine the relative impact of IVL on acute and long-term outcomes specifically in calcified nodules (CNs). METHODS: Individual patient-level data (N=155) were pooled from the Disrupt CAD optical coherence tomography (OCT) substudies. Severely calcified lesions with and without CNs were compared by OCT for acute procedural results and for target lesion failure (TLF) at 2 years - a composite of cardiac death, target vessel myocardial infarction, and ischaemia-driven target lesion revascularisation. RESULTS: (IQR 5.5, 8.5) and 89.7% (IQR 79.8, 102.5), respectively. The cumulative incidence of TLF at 2 years was 13.9% and 8.0% in the CN and non-CN groups, respectively (p=0.32). CONCLUSIONS: Despite a greater calcium volume in CNs, IVL use was associated with comparable stent expansion and luminal gain in both CN and non-CN lesions. Further studies powered for clinical outcomes comparing different plaque modification techniques in this lesion subset are warranted.