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26-A-20953-ACC INTRAVASCULAR LITHOTRIPSY VS ATHERECTOMY FOR SINGLE-VESSEL DES PCI: COMPARATIVE OUTCOMES FROM A MULTICENTER PROPENSITY-MATCHED REGISTRY
Abstract   Peer reviewed

26-A-20953-ACC INTRAVASCULAR LITHOTRIPSY VS ATHERECTOMY FOR SINGLE-VESSEL DES PCI: COMPARATIVE OUTCOMES FROM A MULTICENTER PROPENSITY-MATCHED REGISTRY

Charles Dylan Miks, Grant Ozaki and Vikram Sharma
Journal of the American College of Cardiology, Vol.87(13 Supplement), pp.A441-A442
04/2026
DOI: 10.1016/j.jacc.2026.02.1078

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Abstract

Background Calcified coronary lesions increase PCI complexity. Atherectomy (ATH) has long been the standard for calcium modification but carries procedural risks. Intravascular lithotripsy (IVL) is an emerging alternative with favorable safety, but large-scale comparative data are limited. Methods We analyzed TriNetX data (2013-2024) for patients undergoing single-vessel DES PCI using IVL or ATH. After propensity matching for 31 variables (n=5,768 each), 1-year outcomes, 30-day complications, and annual incidence trends were compared. Results IVL lowered 1-year mortality (RR 0.64; 95% CI 0.58-0.72; p<0.0001), acute MI (RR 0.80; 95% CI 0.66-0.96; p=0.0166), and MACE (RR 0.71; 95% CI 0.62-0.82; p<0.0001) compared to ATH (Figure 1). Procedural complications were reduced with IVL (RR 0.77; 95% CI 0.61-0.97; p=0.0271), driven by less bleeding (RR 0.44; 95% CI 0.31-0.62; p<0.0001) and AKI/CIN (RR 0.71; 95% CI 0.55-0.91; p=0.0068). IVL utilization increased rapidly and surpassed ATH use after 2022, with divergent trends confirmed on logistic regression analysis (p<0.0001). Conclusion In one of the largest real-world registry analyses to date, IVL during single-vessel DES PCI was associated with improved 1-year outcomes and fewer procedural complications than ATH, supporting IVL as a safe, effective alternative that is experiencing rapidly expanding adoption.

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