Clinical Outcomes of Intravascular Lithotripsy in Diabetic Patients with Stent Failure: Insights from the COIL Registry

Background/Objectives: Although still considered off-label, there are accumulating data demonstrating that intravascular lithotripsy (IVL) is safe and effective in treating patients with stent failure (SF). Diabetes (DM) is an independent predictor of recurrent SF. Whether IVL has a differential treatment effect depending on the diabetic status of SF patients undergoing IVL has never been studied. Therefore, we aimed to compare IVL outcomes in patients with SF and concomitant DM versus non-DM counterparts. Methods: This is a pre-specified subgroup analysis of the COIL registry (coronary intravascular lithotripsy in patients with stent failure), which included patients who underwent IVL for SF, divided according to the patients’ diabetic status. Procedural and clinical outcomes were compared between DM and non-DM patients. The primary clinical endpoint was major adverse clinical event (MACE) defined as the composite of cardiovascular death, spontaneous myocardial infarction, or target vessel revascularization (TVR) at one-year follow-up. Results: There were 102 patients enrolled in the coronary intravascular lithotripsy in patients with stent failure (COIL) registry, of whom 47 (46.1%) had DM. Most baseline clinical characteristics were similar between the groups, although patients with DM had higher rates of hypertension and hypercholesterolemia. The use of intracoronary imaging (53% and 56%, respectively, p = 0.75) and the procedural success rate (77% vs. 80%, p = 0.68) were similar in DM and non-DM patients. No difference was observed in the incidence of in-hospital (2.1% vs. 1.8%, p = 0.91) and one-year MACE (12.8% vs. 18.2%, p = 0.45). Conclusions: In patients undergoing IVL for the treatment of SF, procedural and one-year clinical outcomes did not differ significantly between DM and non-DM patients, although the limited sample size should be acknowledged.