Lee Kyu, Roy Priya, Ahmad Umair, Chan Paul S, Gumina Richard J, Kennedy Kevin, Hejjaji Vittal, Malik Ali O
Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Division of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
J Soc Cardiovasc Angiogr Interv. 2025 May 1;4(7):103615. doi: 10.1016/j.jscai.2025.103615. eCollection 2025 Jul.
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.
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.
Mean age was 70.9 ± 10.6 years, 69.4% were men, and 82.3% were of White race. Atherectomy/IVL was used in 33.0% of PCIs in severely calcified arteries. There was an inverse, graded relationship between SDI and atherectomy/IVL use. These differences were only partially attenuated after adjusting for patient and PCI characteristics. Compared with those residing in neighborhoods with the lowest quartile of social deprivation, those in the third and fourth quartiles of social deprivation were 10% (odds ratio, 0.90; 95% CI, 0.88-0.92; < .001) and 8% (odds ratio, 0.92; 95% CI, 0.90-0.94; < .001), respectively, less likely to have atherectomy/IVL used during PCI.
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.
斑块旋切术和血管内碎石术（IVL）有助于在钙化性冠状动脉疾病中进行经皮冠状动脉介入治疗（PCI），使用这些技术与更大的管腔增益和更高的介入成功率相关。随着斑块旋切术/IVL得到更广泛的接受，了解它们在不同社会剥夺水平上的使用差异很重要。
在国家心血管数据注册中心CathPCI注册库中，我们确定了2018年至2023年间因严重钙化病变接受PCI的310124例患者。对于每位患者，我们根据居住邮政编码确定其社会剥夺指数（SDI）。SDI是区域层面社会剥夺的综合指标，值越高表明剥夺程度越高。分层逻辑回归模型评估了SDI与斑块旋切术/IVL使用之间的关联。
平均年龄为70.9±10.6岁，69.4%为男性，82.3%为白人。在严重钙化动脉的PCI中，33.0%使用了斑块旋切术/IVL。SDI与斑块旋切术/IVL的使用呈反向分级关系。在调整患者和PCI特征后，这些差异仅部分减弱。与居住在社会剥夺程度最低四分位数社区的患者相比，社会剥夺程度处于第三和第四四分位数的患者在PCI期间接受斑块旋切术/IVL的可能性分别降低10%（比值比，0.90；95%CI，0.88 - 0.92；P <.001）和8%（比值比，0.92；95%CI，0.90 - 0.94；P <.001）。
在美国，社会剥夺程度越高，在严重钙化冠状动脉狭窄的PCI中斑块旋切术/IVL的使用率越低，这突出了这些技术使用方面的潜在差异。
