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• W4384567956 abstract "<h3>Introduction</h3> Treatment of unprotected severely calcified LMCA disease is a complex interventional procedure. Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are safe and effective methods of treating coronary calcification in the non-LMCA setting. This retrospective analysis compared safety and efficacy of IVL and RA in unprotected LMCA disease. <h3>Methods</h3> We analysed IVL and RA procedures performed at a large tertiary hospital in the Northeast of England from January 1, 2019 to April 31, 2022. Unprotected LMCA disease was defined as a (>50%) stenosis without a patent bypass graft to the left anterior descending (LAD) and/or left circumflex (LCx) artery. Eligible patients were admitted either acutely with an acute coronary syndrome (ACS) or electively for treatment of stable angina and were found to have operator-assessed angiographic or intravascular imaging-based evidence of severe coronary artery calcification in a severely stenotic segment. Important exclusion criteria were repeat PCI with IVL and/or RA. Data were collected from Intellect, a national live online database hosted by the National Institute of Cardiovascular Outcomes Research (NICOR) on behalf of the British Cardiovascular Interventional Society (BCIS). Major safety and efficacy endpoints were procedural and angiographic success, defined by stent delivery with <50% residual stenosis and without clinical or angiographic complications, respectively. Other important clinical endpoints were a composite of major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI) or ischemia-driven repeat revascularization at 1 year. <h3>Results</h3> After exclusions, 242 patients were included and classified into 44 LMCA IVL, 81 LMCA RA and 117 non-LMCA IVL cases. Patients with LMCA disease were approximately 3 years older than non-LMCA disease patients (74.3±8.4 versus 71.4±9.3 years). The LMCA cohort was more likely to have mild to moderate aortic stenosis (13.6% versus 6.8%), but less likely to have a history of previous PCI (41.6% versus 57.4%). There was no clinically relevant difference between the three principle groups -- LMCA IVL, LMCA RA and non-LMCA IVL -- with respect to cardiovascular risk factors, clinical presentation, biochemical profile, and pharmacotherapy . There was a high prevalence of diabetes mellitus (40.1%), hypertension (78.5%), and known ischemic heart disease (72.7%). Thirty-seven (21.9%) patients had severe left ventricular systolic dysfunction (ejection fraction ≤35%). Overall, 131 (54.1%) patients had ACS, of whom 22 (16.8%) presented with a STEMI. Procedural and angiographic success rates were ≥84% across all groups (p>0.05). In 3 LMCA IVL and 3 LMCA RA cases arrhythmias and cardiac tamponade complicated the procedures respectively. At 1 year, MACE occurred in 10/44 (22.7%) LMCA IVL, 16/81 (19.8%) LMCA RA and 25/117 (21.4%) cases (p>0.05). <h3>Conclusion</h3> Intravascular lithotripsy for unprotected highly calcified LMCA disease is safe and effective in the short- and medium-term. Its safety and efficacy are comparable to LMCA RA and non-LMCA IVL procedures. The anatomy of the LMCA and the characteristics of IVL make it a good and perhaps superior technique to modify calcified LMCA disease versus other adjunctive therapies. Despite encouraging evidence from this retrospective analysis, randomized control data are needed to further confirm the role of IVL in unprotected calcified LMCA disease. <h3>Conflict of Interest</h3> None" @default.
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• W4384567956 date "2023-06-01" @default.
• W4384567956 modified "2023-10-16" @default.
• W4384567956 title "53 Safety and efficacy of intravascular lithotripsy in unprotected calcified left main coronary artery" @default.
• W4384567956 doi "https://doi.org/10.1136/heartjnl-2023-bcs.53" @default.
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