A large, real-world study shows that intravascular lithotripsy (IVL) is safe and effective in treating patients with acute coronary syndrome (ACS). These data were reported by Dean J. Kereiakes, MD, of the Christ Hospital and Lindner Research Center, Cincinnati, and colleagues, in a manuscript published online in JACC: Cardiovascular Interventions. Severely calcified coronary artery lesions in ACS cases can be safely treated with IVL, according to the recent REPLICA-EPIC 18 study (Prospective, Multicenter, Observational, Single-arm Registry of Coronary Lithotripsy for the Management of Calcified Lesions in Spain). However, the Disrupt CAD (coronary artery disease) pivotal studies excluded patients with ACS, and real-world data on the safety and efficacy of IVL for ACS are lacking. This present study used data from the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) CathPCI Registry to look at the use of IVL in patients with ACS between February 2021 and July 2022. A total of 18,893 patients (mean age=73 years, 33% women) underwent percutaneous coronary intervention (PCI) with the C2 Coronary IVL System (Shockwave Medical). Of the patients with ACS, 91% had non-ST-segment myocardial infarction (N-STEMI) ACS and 9% had STEMI. A total of 7,503 lesions were treated with IVL in the patients with ACS. Atherectomy was used in 21% of these cases, and 87% of this patient group received a stent. Post-procedure, 97% of lesions had <50% residual restenosis and 94% had <30% residual restenosis. Adverse cardiovascular events were observed in 11.7% of patients. The most common adverse events were cardiac arrest (3.4%), cardiogenic shock (2.5%) and heart failure (2.2%). Mortality was observed in 4.24% of patients (4.49% predicted by NCDR-derived bedside risk score [BRS], risk ratio [RR]=0.94, 95% confidence interval [CI]=0.84-1.06, p=0.35). BRS-predicted rates were similar in the subset of ACS patients with or without STEMI. Overall, the investigators noted that this study was the largest real-world analysis of the use of IVL in patients with ACS and demonstrated that IVL is well-suited to treat ACS. Source: Kereiakes DJ, Shlofmitz RA, Klein RA, et al. Coronary intravascular lithotripsy in the treatment of acute coronary syndrome: The ACC NCDR CathPCI Registry. JACC Cardiovasc Interv. 2025 March 19 (Article in press). Image Credit: ibreakstock – stock.adobe.com