Clinical and Technical Predictors of Adverse Cardiovascular Events Following Coronary Lithotripsy in the BENELUX-IVL Registry

Intravascular lithotripsy (IVL) has emerged as a viable treatment option for calcified coronary lesions. This study aimed to identify clinical and procedural factors associated with major adverse cardiovascular events (MACE) following IVL. This retrospective analysis included 583 patients (72.9 ± 9 years, 74% male) treated with IVL for 612 lesions from the multicenter BENELUX-IVL registry (May 2019-December 2024). Kaplan-Meier analysis was performed to evaluate survival probability. Binary logistic regression analysis was performed to identify predictors of MACE, including cardiac death, nonfatal myocardial infarction (MI) or clinically driven target vessel revascularization (TVR) at 1-year follow-up. Patients presented with acute coronary syndrome in 246 cases (42%), while a variety of target lesions was treated, including in-stent lesions (n = 185, 30%), aorta-ostial lesions (n = 148=24%), bifurcation lesions (n = 135, 22%) and chronic total occlusions (CTOs)(n = 45, 7%). MACE occurred in 44 patients (11%) at 1-year and in 53 patients (18%) at 2-years follow-up. Occurrence of procedural complications (p <0.001), CTOs (p = 0.020), in-stent lesions (p = 0.044), post-IVL plaque modification (p = 0.003) and greater postprocedural residual diameter stenosis on fluoroscopy (p = 0.006) were associated with the occurrence of MACE, while MI in the medical history (p = 0.001) was negatively associated with MACE. Following treatment with IVL in a real-world registry, clinical outcomes up to 2-years follow-up were favorable. Procedural complications, CTOs, in-stent lesions, performance of post-IVL plaque modification and greater postprocedural residual diameter stenosis on fluoroscopy were independent risk factors for experiencing MACE at 1-year follow-up. In contrast, a history of MI was associated with a lower risk of MACE.