OBJECTIVES: Coronary intravascular lithotripsy (IVL) and coronary atherectomy are increasingly used for calcified coronary lesions, yet comparative data on their cardiovascular benefits remain limited. This real-world study compared outcomes of coronary IVL vs atherectomy using the TriNetX Global Collaborative Network. METHODS: Adult patients (≥18 years) undergoing PCI with either IVL or atherectomy between 2021 and 2024 were identified using procedural and diagnosis codes. Propensity score matching (1:1) balanced baseline demographics, comorbidities, laboratory values, and concomitant medications. The primary endpoint was all-cause mortality (ACM), while secondary endpoints included major adverse cardiovascular events (MACE), heart failure exacerbation (HFE), and procedural safety outcomes. RESULTS: Among 51 856 patients, 18 686 underwent IVL and 33 170 underwent atherectomy. After matching, 13 617 patients were retained in each group. At 30 days, IVL was associated with significantly lower risks of ACM (risk ratio RR: 0.67; 95% CI, 0.60-0.75; P < .001), MACE (RR: 0.42, 95% CI, 0.36-0.48; P < .001), and HFE (RR: 0.64; 95% CI, 0.57-0.72; P < .001) compared with atherectomy. These benefits persisted at 1 year for ACM (RR: 0.78; 95% CI, 0.73-0.84; P < .001), MACE (RR: 0.66; 95% CI, 0.60-0.72; P < .001), and HFE (RR: 0.79; 95% CI, 0.73-0.85; P < .001). Safety outcomes were comparable between groups. CONCLUSIONS: In this propensity-matched, real-world cohort, IVL was associated with lower mortality and fewer adverse cardiovascular events than atherectomy, with a comparable safety profile. Given the likelihood of residual selection bias, these observational findings require confirmation in randomized trials.
Jaiswal et al. (Mon,) studied this question.