Incidence of Periprocedural Myocardial Injury and Infarction After Intravascular Lithotripsy for Calcified Coronary Artery Stenosis

BACKGROUND: Intravascular lithotripsy (IVL) has emerged as an effective technique for modifying heavily calcified coronary plaques, facilitating optimal stent expansion while minimizing procedural complications. However, data on periprocedural myocardial injury (PMI) and infarction (PPMI) following IVL remain scarce. AIMS: To evaluate the incidence of PMI and PPMI after IVL in an unselected real-world population undergoing percutaneous coronary intervention (PCI). METHODS: All consecutive patients treated with IVL between May 2020 and December 2022 at a single tertiary center were included. Pre- and post-procedural cardiac biomarkers (high-sensitivity troponin T, CK, CK-MB) and electrocardiograms were systematically analyzed. PMI and PPMI were defined according to the Fourth Universal Definition of Myocardial Infarction. A matched control cohort (2147 non-IVL PCI patients) was used to compare biomarker dynamics. RESULTS: Among 90 patients (mean age 73 ± 9 years; 77% male), diameter stenosis decreased from 55.2% ± 15.5% before IVL to 40.3% ± 15.7% immediately after IVL, with a final residual stenosis of 5.5% ± 18.5% after PCI and increased median minimal lumen diameter from 1.22 [0.72-1.72] mm to 3.04 [2.64-3.57] mm. High-sensitivity troponin and CK-MB levels rose modestly following IVL-assisted PCI (p < 0.001), indicating mild myocardial injury. PMI was present in 49 patients (54%). Two patients met the criteria for PPMI, and no major procedural complication occurred. In an exploratory matched-control analysis, IVL was associated with a moderate but statistically significant increase in biomarkers compared with matched controls (Cohen's d = 0.40). CONCLUSION: In this single-center observational study, IVL was associated with limited myocardial injury, while clinically overt PPMI remained uncommon. These findings support the favorable safety profile of IVL as a plaque-modification strategy for complex calcified coronary lesions. CLINICALTRIALS: gov Identifier: NCT04185285.