Disparities in the Use of Atherectomy and Intravascular Lithotripsy for Percutaneous Coronary Intervention

Background: Atherectomy and intravascular lithotripsy (IVL) facilitate percutaneous coronary intervention (PCI) in calcified coronary disease, and use of these technologies is associated with greater luminal gain and superior intervention success. As atherectomy/IVL gain more widespread acceptance, it is important to understand whether their use differs across levels of social deprivation. Methods: Within the National Cardiovascular Data Registry CathPCI Registry, we identified 310,124 patients who had a PCI for severely calcified lesions between 2018 and 2023. For each patient, we determined their social deprivation index (SDI) based on residential zip codes. The SDI is a composite measure of area-level social deprivation, with higher values correlating to greater deprivation. Hierarchical logistic regression models evaluated the association of SDI with use of atherectomy/IVL. Results: < .001), respectively, less likely to have atherectomy/IVL used during PCI. Conclusions: In the United States, greater social deprivation was associated with lower rates of atherectomy/IVL during PCI for severely calcified coronary artery stenoses, highlighting potential disparities in use of these technologies.