Butala Neel M, Waldo Stephen W, Secemsky Eric A, Kennedy Kevin F, Spertus John A, Rymer Jennifer A, Rao Sunil V, Messenger John C, Yeh Robert W
Rocky Mountain Regional VA Medical Center, Aurora, Colorado.
University of Colorado School of Medicine, Aurora, Colorado.
J Soc Cardiovasc Angiogr Interv. 2024 Jan 22;3(2):101254. doi: 10.1016/j.jscai.2023.101254. eCollection 2024 Feb.
Calcified coronary lesions are a challenge for percutaneous coronary interventions (PCIs). Coronary intravascular lithotripsy (IVL) is a novel calcium modification technology approved for commercial use in February 2021, but little is known about its uptake in US clinical practice.
We described trends in use of calcium modification strategies, variation in use across hospitals, and predictors of calcium modification and IVL use in PCI. We included National Cardiovascular Data Registry CathPCI Registry patients who underwent PCI between April 1, 2018, and December 31, 2022. We examined trends and hospital variation in calcium modification and IVL use. We used multivariate hierarchical logistic regression to identify predictors of calcium modification and IVL use at hospitals in 2022.
Of 2,733,494 PCIs across 1676 hospitals over 4.75 years, 11.4% were performed with calcium modification. Coronary IVL use increased rapidly from 0% of PCIs in Q4 2020 to 7.8% of PCIs in Q4 2022, which was accompanied by an overall increase in use of all calcium modification strategies (11.1%-16.0%) during this period with a slight corresponding decrease in coronary atherectomy use (5.4%-4.4%). In 2022, there was wide variation in IVL use across hospitals (median, 3.86%; IQR, 0%-8.19%), with IVL being the most common calcium modification strategy in 48% of hospitals. The treating hospital was the strongest predictor of calcium modification (median odds ratio [OR], 2.49; 95% CI, 2.40-2.57) and IVL use (median OR, 2.89; 95% CI, 2.74-3.04).
IVL has rapidly changed the landscape of calcium modification use for PCI, although there remains wide variation across hospitals.
钙化性冠状动脉病变是经皮冠状动脉介入治疗（PCI）面临的一项挑战。冠状动脉血管内碎石术（IVL）是一项于2021年2月获批投入商业使用的新型钙修饰技术，但对于其在美国临床实践中的应用情况知之甚少。
我们描述了钙修饰策略的使用趋势、各医院使用情况的差异，以及PCI中钙修饰和IVL使用的预测因素。我们纳入了2018年4月1日至2022年12月31日期间接受PCI的国家心血管数据注册中心CathPCI注册患者。我们研究了钙修饰和IVL使用的趋势及医院差异。我们使用多变量分层逻辑回归来确定2022年各医院钙修饰和IVL使用的预测因素。
在4.75年的时间里，1676家医院共进行了2,733,494例PCI，其中11.4%的手术采用了钙修饰。冠状动脉IVL的使用从2020年第四季度PCI的0%迅速增加到2022年第四季度PCI的7.8%，在此期间，所有钙修饰策略的使用总体增加（从11.1%增至16.0%），而冠状动脉旋切术的使用相应略有下降（从5.4%降至4.4%）。2022年，各医院IVL的使用差异很大（中位数为3.86%；四分位间距为0% - 8.19%），在48%的医院中，IVL是最常用的钙修饰策略。治疗医院是钙修饰（中位数优势比[OR]为2.49；95%置信区间为2.40 - 2.57）和IVL使用（中位数OR为2.89；95%置信区间为2.74 - 3.04）的最强预测因素。
尽管各医院之间仍存在很大差异，但IVL已迅速改变了PCI中钙修饰的使用格局。
