ArticleCardiology journal2026
Intravascular lithotripsy for calcified coronary lesions: contemporary trends and long-term outcomes in acute myocardial infarction patients - insights from the CLEAR registry.
Article in Cardiology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntravascular lithotripsy (IVL) utilizes high-energy sonic waves to create controlled fractures in calcified plaques, facilitating vessel preparation and improving stent apposition.
methodsThe study was designed to evaluate the safety and efficacy of IVL in a patient population that included individuals with acute myocardial infarction (MI). A total of 201 consecutive patients who underwent percutaneous coronary intervention (PCI) using IVL [Shockwave C2 or C2+ (Shockwave Medical Inc, Santa Clara, CA, US)] from April 2020 onward were included in this single-center registry. The study population comprised 76 patients with acute MI (Group 1) and 125 patients with non-MI (Group 2).
resultsLeft ventricular ejection fraction was lower (46.0% ± 13.1% vs. 50.9% ± 10.5%; p = 0.022), while SYNTAX Score was significantly higher (20.0 ± 11.3 vs. 16.5 ± 10.2; p = 0.059) in Group 1 than in Group 2 (46.0% ± 13.1% vs. 50.9% ± 10.5%; p = 0.022). The overall IVL success rate and procedure success rate were very high (97.5% and 99.5%, respectively). A mean increase in lumen area was observed in Group 1 and Group 2: 5.9 ± 3.7 mm2 vs. 4.5 ± 2.2 mm2 and 237% vs. 239%, respectively. In the long-term follow-up there was no difference in all-cause mortality between Group 1 and Group 2 (9.0% vs. 8.1%; p = 0.997), cardiac death (p = 0.340), repeat MI (p = 0.986) and major adverse cardiovascular events [MACE; cardiac death, myocardial infarction, stroke] (16.8% vs. 9.8%; p = 0.501). Prior chronic kidney disease (CKD), post rota-atherectomy debulking, prior coronary artery bypass graft (CABG) and longer lesions were independent predictors of long-term all-cause mortality.
conclusionsIntravascular lithotripsy is an effective treatment for the modification of calcified atherosclerotic lesions, with a high success rate and few periprocedural complications. The long-term outcomes achieved in this complex population are satisfactory.
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