Oliveri Federico, van Oort Martijn J H, Al Amri Ibthial, Bingen Brian O, Claessen Bimmer E, Dimitriu-Leen Aukelien C, Kefer Joelle, Girgis Hany, Vossenberg Tessel, van der Van der Kley Frank, Jukema J Wouter, Montero-Cabezas Josè M
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Catheter Cardiovasc Interv. 2025 Feb;105(2):385-393. doi: 10.1002/ccd.31307. Epub 2024 Nov 24.
Despite the excellent success and safety of intravascular lithotripsy (IVL) in heavily calcified lesions, evidence in acute coronary syndromes (ACS) remains limited.
This study aimed to evaluate the procedural and clinical outcomes of IVL in heavily calcified ACS.
Patients who underwent IVL between 2019 and 2024 from the ongoing prospective BENELUX registry were eligible for inclusion. Patients were therefore classified in ACS and chronic coronary syndrome (CCS) groups. The primary technical endpoint was angiographic success < 30%, defined as the successful delivery of the IVL catheter across the target lesion and delivery of IVL pulses without angiographic complications and residual target lesion less than 30%. The primary clinical endpoint was in-hospital major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, or target lesion revascularization.
A total of 454 patients underwent IVL, with 251 (55.3%) treated for CCS and 203 (44.7%) for ACS. The median SYNTAX score (p-value 0.17), the need for inotropes (p-value 0.09), and the use of mechanical circulatory support (p-value 0.71) were similar between CCS and ACS groups. Comparable angiographic success (< 30% residual stenosis) was observed between CCS and ACS groups (90.1% vs. 91.1%, p = 0.69). MACE were similar across groups during hospital stays (CCS 1.6% vs. ACS 3.0%, p = 0.33), at 30 days (CCS 3.2% vs. ACS 3.9%, p = 0.86), and at 12-month follow-up (CCS 8.4% vs. ACS 7.9%, p = 0.91).
IVL provides high procedural success and consistent clinical outcomes in both CCS and ACS cases.
尽管血管内碎石术（IVL）在严重钙化病变中取得了优异的成功率和安全性，但在急性冠状动脉综合征（ACS）中的证据仍然有限。
本研究旨在评估IVL在严重钙化ACS中的手术和临床结果。
纳入2019年至2024年期间正在进行的前瞻性比荷卢登记处接受IVL治疗的患者。因此，患者被分为ACS组和慢性冠状动脉综合征（CCS）组。主要技术终点是血管造影成功<30%，定义为IVL导管成功穿过靶病变并输送IVL脉冲，无血管造影并发症且残余靶病变小于30%。主要临床终点是住院期间主要不良心脏事件（MACE），包括心源性死亡、非致命性心肌梗死或靶病变血运重建。
共有454例患者接受了IVL治疗，其中251例（55.3%）接受CCS治疗，203例（44.7%）接受ACS治疗。CCS组和ACS组之间的中位SYNTAX评分（p值0.17）、使用血管活性药物的需求（p值0.09）和机械循环支持的使用（p值0.71）相似。CCS组和ACS组之间观察到类似的血管造影成功率（残余狭窄<30%）（90.1%对91.1%，p = 0.69）。住院期间、30天时和12个月随访时，各组间MACE相似（CCS组1.6%对ACS组3.0%，p = 0.33），（CCS组3.2%对ACS组3.9%，p = 0.86），（CCS组8.4%对ACS组7.9%，p = 0.91）。
IVL在CCS和ACS病例中均提供了较高的手术成功率和一致的临床结果。
