Comparison of Short-Term Clinical Outcomes Between Intravascular Lithotripsy and Rotational Atherectomy for Calcified Coronary Stenosis in Patients With Acute Coronary Syndrome.

Background: The optimal revascularization strategy for calcified lesions in patients with acute coronary syndrome (ACS) remains unclear. This study aimed to compare the short-term outcomes of intravascular lithotripsy (IVL) and rotational atherectomy (RA) for patients with ACS resulting from calcified lesions. Methods and Results: Among 3,556 consecutive patients with ACS who underwent primary percutaneous coronary intervention (PCI) between 2016 and 2024, we retrospectively analyzed 52 patients who received drug-eluting stents with either IVL (n=24) or RA (n=28) for calcified lesions. The primary outcome was the incidence of major adverse cardiovascular events (MACE). In addition, we evaluated slow-flow or no-reflow phenomena incidence during PCI and the procedural success rate. Compared with patients with RA, those with IVL had a smaller preprocedural minimum lumen diameter and a larger preprocedural reference vessel diameter. Primary outcomes and procedural success rates were comparable between both groups. However, the slow-flow or no-reflow incidence was significantly lower in the IVL group than in the RA group. After adjusting for confounders, IVL was independently associated with a lower slow-flow or no-reflow incidence. Conclusions: In patients with ACS due to calcified lesions, there was no significant difference in 30-day MACE incidence between both groups. However, slow-flow incidence was lower in the IVL group.