Coronary Intravascular Lithotripsy Versus Rotational Atherectomy in an Asian Population: Clinical Outcomes in Real-World Patients

다국어 초록 (Multilingual Abstract)

Background and Objectives: We compared real-world clinical outcomes of patients receiving intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for heavily calcified coronary lesions.
Methods: Fifty-three patients who received IVL from January 2017 to July 2020 were retrospectively compared to 271 patients who received RA from January 2017 to December 2018. Primary endpoints were in-hospital and 30-day major adverse cardiovascular events (MACE).
Results: IVL patients had a higher prevalence of acute coronary syndrome (56.6% vs 24.4, p<0.001), multivessel disease (96.2% vs 73.3%, p<0.001) and emergency procedures (17.0% vs 2.2%, p<0.001) compared to RA. In-hospital MACE (11.3% vs 5.9%, p=0.152), MI (7.5% vs 3.3%, p=0.152), and mortality (5.7% vs 3.0%, p=0.319) were not statistically significant. 30-day MACE was higher in the IVL cohort vs RA (17.0% vs 7.4%, p=0.035). Propensity score adjusted regression using IVL was also performed on in-hospital MACE (odds ratio [OR], 1.677; 95% confidence interval [CI], 0.588–4.779) and 30-day MACE (OR, 1.910; 95% CI, 0.774–4.718).
Conclusions: These findings represent our initial IVL experience in a high-risk, real-world cohort. Although the event rate in the IVL arm was numerically higher compared to RA, the small numbers and retrospective nature of this study preclude definitive conclusions. These clinical outcomes are likely to improve with greater experience and better case selection, allowing IVL to effectively treat complex calcified coronary lesions.

참고문헌 (Reference)

1 Chuang ML, "Textbook of Interventional Cardiology" Elsevier 1052-1068, 1994

2 Ali ZA, "Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses : the disrupt CAD II study" 12 : e008434-, 2019

3 de Waha S, "Rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions : two-year clinical outcome of the randomized ROTAXUS trial" 87 : 691-700, 2016

4 Umapathy S, "Real-world experience of coronary intravascular lithotripsy in an Asian population : a retrospective, observational, single-center, all-comers registry" 33 : E417-24, 2021

5 Garland JS, "Prevalence and associations of coronary artery calcification in patients with stages 3 to 5 CKD without cardiovascular disease" 52 : 849-858, 2008

6 Chambers JW, "Pivotal trial to evaluate the safety and efficacy of the orbital atherectomy system in treating de novo, severely calcified coronary lesions(ORBIT II)" 7 : 510-518, 2014

7 Doshi R, "Orbital atherectomy via transradial access : a multicenter propensity-matched analysis" 31 : 325-330, 2019

8 De Maria GL, "Management of calcific coronary artery lesions : is it time to change our interventional therapeutic approach?" 12 : 1465-1478, 2019

9 Aksoy A, "Intravascular lithotripsy in calcified coronary lesions : a prospective, observational, multicenter registry" 12 : e008154-, 2019

10 Hill JM, "Intravascular lithotripsy for treatment of severely calcified coronary artery disease" 76 : 2635-2646, 2020

11 Abdel-Wahab M, "High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions : the randomized ROTAXUS(Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease)trial" 6 : 10-19, 2013

12 Thygesen K, "Fourth universal definition of myocardial infarction(2018)" 138 : e618-51, 2018

13 Brinton TJ, "Feasibility of shockwave coronary intravascular lithotripsy for the treatment of calcified coronary stenoses" 139 : 834-836, 2019

14 Wood S, "FDA approves shockwave intravascular lithotripsy for calcified coronaries" TCTMD

15 Arora S, "Coronary atherectomy in the United States(from a nationwide inpatient sample)" 117 : 555-562, 2016

16 Madhavan MV, "Coronary artery calcification : pathogenesis and prognostic implications" 63 : 1703-1714, 2014

17 National Heart Centre Singapore, "Clinical sciences & statistics core" National Heart Centre Singapore

18 Aziz A, "37 Shockwave intravascular lithotripsy in calcified coronary lesions : a retrospective, observational, international multi-centre analysis" 106 : A33-, 2020

19 Valgimigli M, "2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS : the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology(ESC)and of the European Association for Cardio-Thoracic Surgery(EACTS)" 39 : 213-260, 2018

20 Levine GN, "2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease : a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines : an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery" 134 : e123-55, 2016