Data from ACC's CathPCI Registry suggest a "favorable safety profile" for use of coronary intravascular lithotripsy (IVL) in treating patients presenting with acute coronary syndromes (ACS), according to a study published March 19 in JACC: Cardiovascular Interventions.

Dean J. Kereiakes, MD, FACC, et al., looked at 18,893 patients (mean age 73.1 ± 10.2 years, 67% men) who underwent PCI with the C² Coronary IVL System from February 2021 to July 2022. Of the patients presenting with ACS (36%), 91% were NSTEMI and 9% were STEMI.

Looking overall at lesions treated with IVL, atherectomy was used in 21% and 87% received a stent. Residual stenosis after PCI was 3.4% ± 12.5% (97% of lesions had <50% residual stenosis and 94% had <30% residual stenosis), and both coronary artery perforations and significant dissections occurred infrequently (0.6% and 0.8%, respectively).

Adverse events were observed in 11.7% of patients, with cardiac arrest (3.4%), cardiogenic shock (2.5%) and heart failure (2.2%) noted as the most common complications. Observed in-hospital mortality rates were consistent with those predicted by the validated NCDR-derived bedside risk score (4.24% observed, 4.49% predicted; relative risk: 0.94; 95% CI: 0.84-1.06; p=0.35), with no significant differences in observed vs. predicted rates for either STEMI or NSTEMI patients alone.

"IVL appears well suited for the treatment of patients with ACS, as its mechanism of action (transmitting acoustic pressure waves) modifies calcific lesions with a low risk for distal embolization, dissection or perforation," write the authors.

They qualify their findings by emphasizing the need for additional investigations of IVL use in patients with ACS, stating that "longer term prospective studies are necessary to confirm the durability of the therapy in this setting."