Abstract 15039: Procedural and Cardiovascular Outcomes of Intravascular Lithotripsy and Rotational Atherectomy for Calcified Coronary Artery Lesions: A Systematic Review and Meta-Analysis

Abstract

Introduction: Calcified coronary lesions (CCL) are associated with higher peri-procedural complications and long-term morbidity and mortality. Treatment of CCL require preparation prior to stenting, with rotational atherectomy (RA) and intravascular lithotripsy (IVL) frequently utilized for lesion preparation. There are limited comparative studies assessing procedural and cardiovascular endpoints between RA and IVL. This meta-analysis will compare procedural and cardiovascular outcomes in patients undergoing RA versus IVL. Hypothesis: We hypothesize that there are no significant differences in major cardiovascular outcomes between RA and IVL, however differences in procedural parameters may be present. Methodology: A systematic literature search of medical databases using PRISMA principles identified all relevant studies comparing RA vs IVL in CCL (PROSPERO CRD42023411701). Data for all variables were extracted and those with low heterogeneity were then meta-analyzed using a random-effect model for odds ratios (OR) or standardized mean differences (SMD). Primary outcomes assessed were of major adverse cardiovascular events (MACE) and death, whilst secondary outcomes were procedural parameters and complications. Results: 170 studies were screened, of which 4 peer-reviewed articles and 3 abstracts fulfilled criteria for inclusion. Abstracts were included to increase power. No significant between group differences were observed in contrast volume, coronary dissections and perforations, slow or no-reflow, in-hospital MACE and cardiovascular (CV) death, as well as follow-up stent thrombosis and primary CV outcomes. Of note, IVL had shorter fluoroscopy times (SMD 0.560; p<0.001) and greater use of intracoronary imaging guidance (OR 0.295; p=0.007). Conclusion: No significant differences in major cardiovascular outcomes were found between RA and IVL in treatment of CCL, however differences in procedural parameters were appreciated.