Clinical Outcomes of Intravascular Lithotripsy for Severely Calcified Coronary Lesions: A Single-Center Study.

Background: Intravascular lithotripsy (IVL) is an emerging calcium modification technique designed to optimize stent expansion in patients with severely calcified coronary artery disease. While clinical trials support its efficacy, real-world data from Asia remain limited. Objectives: To evaluate the procedural success, safety, and 1-year clinical outcomes of IVL in a single-center Taiwanese cohort. Methods: This retrospective single-center cohort study enrolled patients undergoing IVL for complex calcified coronary lesions between November 2022 and October 2024. Results: The 1-year MACE rate was 13.6% (raw proportion), driven by cardiac death (1.5%), myocardial infarction (4.5%), ischemia-driven target vessel revascularization (7.6%), and prior in-stent restenosis requiring repeat revascularization (3.0%). The Kaplan-Meier-estimated 1-year cumulative incidence of MACEs was 14.9%. Subgroup analyses showed significantly higher MACE and revascularization rates in patients with end-stage renal disease (ESRD) (p = 0.004, 0.012) and in non-bifurcation lesions (p = 0.014). Multivariable analysis identified ESRD as an independent predictor of MACEs (hazard ratio [HR]: 5.790, p = 0.004) and revascularization (HR: 7.233, p = 0.015); stent under-expansion was also independently associated with revascularization (HR: 7.030, p = 0.010). These findings highlight the clinical performance of IVL and key predictors of adverse outcomes. Conclusions: IVL appears to be safe and effective for managing complex calcified coronary lesions. Outcomes in this study were influenced by renal dysfunction and stent expansion.