Intravascular Lithotripsy Is Associated With Superior Clinical Outcomes Compared to Atherectomy: A Large‐Scale, Propensity‐Matched Analysis

Figures

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  Figure 1. Love Plot for SMD of Baseline Characteristics Before and After Propensity Matching. Covariates are ordered by decreasing order of SMD prior to matching. The vertical dashed line (gray) indicates an absolute SMD = 0.1 threshold for acceptable balance, and all covariates met this threshold after matching (blue). Lesion imaging and procedural details were not available for matching. AF/AFL = atrial fibrillation and flutter, CKD = chronic kidney disease, CABG = coronary artery bypass grafting, CAD = coronary artery disease, CM = cardiomyopathy, COPD = chronic obstructive pulmonary disease, CTO = chronic total occlusion, CVA = ischemic stroke, DM = diabetes mellitus, HFrEF = heart failure with reduced ejection fraction, HFpEF = heart failure with preserved ejection fraction, HLD = hyperlipidemia, HTN = hypertension, ICM = ischemic cardiomyopathy, PCI = percutaneous coronary intervention, PVD = peripheral vascular disease, SMD = standardized mean difference, TIA = transient ischemic attack. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 2. Forest plot for primary outcomes for single‐vessel DES placement using IVL versus ATH at 1 year. RR and 95% CI are shown for each endpoint in blue, with the dashed vertical line representing RR = 1.0 shown in red. RR values < 1.0 favor IVL. IVL was associated with significantly lower all‐cause mortality, acute MI, and MACE compared with ATH. Differences in stroke, in‐stent restenosis, and revascularization (PCI/CABG) were not statistically significant. ATH = atherectomy, CABG = coronary artery bypass grafting, CI = confidence interval, DES = drug‐eluting stent, IVL = intravascular lithotripsy, MACE = major adverse cardiovascular events, MI = myocardial infarction, PCI = percutaneous coronary intervention, RR = risk ratio. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 3. Kaplan‐Meier survival curves for all‐cause mortality at 1 year following single‐vessel PCI with DES placement using either IVL or ATH. Shaded regions indicate 95% confidence intervals. IVL (blue) demonstrated reduced 1‐year mortality compared to ATH (red). Number‐at‐risk tables are not available due to de‐identified aggregate output data. ATH = atherectomy, CI = confidence interval, DES = drug‐eluting stent, HR = hazards ratio, IVL = intravascular lithotripsy, PCI = percutaneous coronary intervention. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 4. Kaplan‐Meier survival curves for MACE at 1 year following single‐vessel PCI with DES placement using either IVL or ATH. Shaded regions indicate 95% confidence intervals. IVL (blue) demonstrated reduced 1‐year MACE compared to ATH (red). Number‐at‐risk tables are not available due to de‐identified aggregate output data. ATH = atherectomy, CI = confidence interval, DES = drug‐eluting stent, HR = hazards ratio, IVL = intravascular lithotripsy, MACE = major adverse cardiovascular events, PCI = percutaneous coronary intervention. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 5. Forest Plot for 30‐Day Procedural Complications Following Single‐Vessel DES Placement Using IVL Versus ATH. RR and 95% CI are shown for each endpoint in blue, with the dashed vertical line representing RR = 1.0 shown in red. RR values < 1.0 favor IVL. IVL was associated with significantly lower rates of any complication, major bleeding, hemopericardium, and CA‐AKI compared with ATH. Differences in coronary dissection, cardiac tamponade, cardiogenic shock, stent thrombosis, mechanical circulatory support, and respiratory failure were not statistically significant. ATH = atherectomy, CA‐AKI = contrast‐associated acute kidney injury, CI = confidence interval, DES = drug‐eluting stent, IVL = intravascular lithotripsy, RR = risk ratio. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 6. Incidence of IVL and ATH with Single‐Vessel DES Placement (2013–2024). Incidence rates were calculated from all available PCI procedures with single‐vessel DES placement during the time window in the TriNetX Research Network. Utilization of IVL (blue) increased rapidly after 2021 and surpassed ATH (red) after 2022, reflecting accelerated real‐world adoption of IVL for the treatment of coronary lesions. Divergent trends were confirmed on logistic regression analysis (p < 0.0001). ATH = atherectomy, DES = drug‐eluting stent, IVL = intravascular lithotripsy, PCI = percutaneous coronary intervention. [Color figure can be viewed at wileyonlinelibrary.com]

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  Central Illutration 1.. Clinical and procedural outcomes of IVL versus coronary atherectomy. Among patients with CAD undergoing first‐time DES placement, IVL was associated with lower all‐cause mortality and MACE at 1 year, along with decreased periprocedural complications of major bleeding, hemopericardium, and CA‐AKI at 30 days, compared to ATH. ATH = atherectomy, CA‐AKI = contrast‐associated acute kidney injury, CAD = coronary artery disease, CI = confidence interval, CKD = chronic kidney disease, DES = drug‐eluting stent, HFrEF = heart failure with reduced ejection fraction, HR = hazard ratio, IVL = intravascular lithotripsy, MACE = major adverse cardiovascular events, MI = myocardial infarction, PCI = percutaneous coronary intervention. [Color figure can be viewed at wileyonlinelibrary.com]