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Canadian Journal of Cardiology

ONE-YEAR OUTCOMES IN PATIENTS WHO UNDERWENT CORONARY INTRAVASCULAR SHOCKWAVE LITHOTRIPSY FOR HIGHLY-CALCIFIED CORONARY LESIONS

      Background

      Intravascular lithotripsy (IVL) has been shown to have excellent angiographic and short-term clinical results in patients with heavily calcified lesions who require percutaneous coronary intervention in both randomized and observational studies. However, there is limited data regarding the long-term outcomes in real-world patients. We conducted a follow up of a high-risk IVL cohort at a tertiary care centre to help better define outcomes over a 1-year period post IVL.

      Methods and Results

      We conducted a retrospective cohort study of 50 consecutive patients who underwent IVL between September 1, 2019 and January 31, 2020. One-year outcomes were available for 47/50 patients; 3 patients who did not survive their index hospitalisation (for reasons unrelated to IVL) were excluded. The primary outcome was need for target vessel revascularization (TVR) at 1 year from index procedure. Secondary outcomes included cardiovascular mortality, myocardial infarction (MI), and freedom from angina. The mean age of the cohort was 71.5 years and 38% of patients were female. Fifty-three percent of patients presented with non-ST elevation ACS as the indication for initial IVL. Twenty-six percent of patients underwent IVL for lesions of the left main coronary artery, and 26% underwent IVL for in-stent restenosis (ISR). Of a total of 47 patients (61 lesions), 4% of patients (3% of lesions) required TVR within 1 year; 96% of patients who underwent IVL remained free from repeat intervention on the same vessel. Two (4%) suffered mortality at one year from non-cardiovascular causes. Eighty-five percent of patients remained free from angina at 1 year. One patient suffered an MI within 1 year; the culprit vessel had not previously been treated with IVL.

      Conclusion

      IVL is associated with favorable results out to 1 year with very low rates of TVR. This suggests that IVL is an effective and durable modality for treatment of highly calcified coronary lesions in high-risk patients, including those requiring IVL for the indication of ACS or ISR.