OR5-1 | Intravascular Lithotripsy Compared With Rotational Atherectomy for Calcified Coronary Lesions: A Meta-Analysis of Outcomes

Rotational atherectomy (RA) and intravascular lithotripsy are increasingly used to optimize lesion preparation during percutaneous coronary intervention (PCI) in patients with severe coronary artery calcification (CAC). There is limited data to assess the superiority of one technique over the other. We aimed to compare the procedural and clinical outcomes for RA and IVL in patients with severe CAC. We systematically searched PubMed, Scopus, and Web of Science for studies comparing periprocedural, angiographic, and clinical outcomes of RA and IVL in patients with severe CAC. Mantel-Haenszel fixed-effects model was used to calculate a pooled estimate of risk ratio (RR) for dichotomous outcomes and associated 95% confidence interval (CI). 5 studies comprising 670 patients with severe CAC undergoing either IVL or RA were included in the analysis. There was no difference in outcomes when comparing IVL and RA including procedural complications [coronary perforation (RR 0.47, 95% CI 0.11-2.11, p=0.33), target vessel revascularization (RR 2.35, 95% CI 0.27-20.86, p=0.44), stent thrombosis (RR 3.02, 95% CI 0.51-17.94, p=0.22)], fluoroscopic times (MD -1.72, 95% CI -4.08-0.63, p=0.15), and short-term clinical outcomes [death (RR 0.69, 95% CI 0.31-1.52, p=0.35), myocardial infarction (RR 1.84, 95% CI 0.75-4.52, p=0.19), stroke (RR 4.40, 95% CI 0.85-22.90, p=0.08), major adverse cardiovascular events (RR 1.30, 95% CI 0.74-2.29, p=0.36)]. Our analysis demonstrated no significant difference in procedural and clinical outcomes when comparing IVL and RA in patients with severe CAC.