BackgroundPercutaneous coronary intervention of calcified aorto‐ostial lesions (AOL) pose unique challenges due to anatomical propensity for recoil, leading to poorer outcomes compared to non‐AOL. Although intravascular lithotripsy (IVL) has shown excellent success and safety in heavily calcified plaques, evidence specific to AOL is limited. This study aims to evaluate the efficacy and safety of IVL in AOL versus non‐AOL.MethodsPatients treated with IVL between 2019 and 2023 from an ongoing prospective multicenter registry were eligible for inclusion. Patients were therefore classified in AOL and non‐AOL groups, based on anatomical location. The primary technical endpoint was device success, defined as the ability to deliver the IVL catheter and pulses at the target lesion, without angiographic complications. Secondary technical endpoint encompassed procedural success <30%, consisting of device success with residual stenosis <30%, final thrombolysis in myocardial infarction grade 3 flow, and no in‐hospital major adverse cardiovascular events (MACE). The primary clinical endpoint was in‐hospital MACE, including cardiac death, nonfatal myocardial infarction, or target lesion revascularization.ResultsA total of 321 patients underwent IVL, including 48 with AOL. Device success showed no significant difference between AOL and non‐AOL groups (100% vs. 98.2%; p = 0.35). A nonsignificant trend toward worse procedural success with residual stenosis <30% was observed in the AOL arm (AOL 81.3% vs. non‐AOL 90.5%, p = 0.06). In‐hospital MACE was significantly higher in AOL (4.2% vs. 0.7%, p = 0.048), attributed entirely to cardiac deaths. At 6‐month follow‐up, the incidence of MACE (AOL 8.3% vs. non‐AOL 4.0%, p = 0.19), and cardiac deaths (AOL 4.2% vs non‐AOL1.1%, p = 0.11) were comparable between groups.ConclusionIVL treatment for heavily calcified AOL demonstrates comparable procedural and 6‐month clinical outcomes when compared to non‐AOL, despite a higher incidence of in‐hospital MACE.

中文翻译：

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冠状动脉内碎石术对严重钙化的主动脉口冠状病变的手术和临床影响


背景由于解剖学上的反冲倾向，钙化主动脉口病变 (AOL) 的经皮冠状动脉介入治疗提出了独特的挑战，导致与非 AOL 相比较差的结果。尽管血管内碎石术 (IVL) 在治疗严重钙化斑块方面显示出出色的成功性和安全性，但针对 AOL 的证据有限。本研究旨在评估 AOL 与非 AOL 中 IVL 的疗效和安全性。方法来自正在进行的前瞻性多中心登记的 2019 年至 2023 年期间接受 IVL 治疗的患者符合纳入条件。因此，根据解剖位置，患者被分为 AOL 组和非 AOL 组。主要技术终点是设备成功，定义为能够在目标病变处输送 IVL 导管和脉冲，且不会出现血管造影并发症。次要技术终点包括手术成功率 <30%，包括装置成功且残留狭窄 <30%、心肌梗死 3 级血流中的最终溶栓，以及无院内主要不良心血管事件 (MACE)。主要临床终点是院内MACE，包括心源性死亡、非致命性心肌梗死或靶病灶血运重建。结果共有321名患者接受了IVL，其中48名患者接受了AOL。 AOL 组和非 AOL 组之间的装置成功率没有显着差异（100% vs. 98.2%；p = 0.35）。在 AOL 组中观察到残余狭窄 <30% 的手术成功率较差的趋势（AOL 81.3% 对比非 AOL 90.5%，p = 0.06）。 AOL 中的院内 MACE 显着较高（4.2% vs. 0.7%，p = 0.048），完全归因于心源性死亡。 6 个月随访时，MACE 发生率（AOL 8.3% 对比非 AOL 4.0%，p = 0.19）和心源性死亡（AOL 4.2% 对比非 AOL1.1%，p = 0）。11) 组间具有可比性。结论 尽管院内 MACE 发生率较高，但与非 AOL 相比，重度钙化 AOL 的 IVL 治疗显示出可比的手术和 6 个月临床结果。