Sex Differences in a Real-World Registry Examining Coronary Lithotripsy for Calcified Lesions

Intravascular lithotripsy (IVL) has been established as a safe and effective treatment for coronary artery calcification (CAC). This study aimed to evaluate sex-related differences in the treatment with IVL in a real-world, all-comers international registry. Patients who underwent IVL between May 2019 and February 2024 were enrolled from the BENELUX-IVL registry. Patients were divided into men and women groups. Efficacy end points included device success (delivery of the IVL balloon across the target lesion and administration of therapy without related complications), technical success (thrombolysis in myocardial infarction 3 flow and residual stenosis <30% by quantitative coronary analysis and/or fluoroscopically) and procedural success (composite of technical success with absence of in-hospital major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). Safety end points were IVL-related complications and MACE at 1-year follow-up. 454 patients (73 ± 9.0 years) were treated with IVL, comprising 342 men (75%) and 112 women (25%). More women presented with acute coronary syndrome (41% in men vs 54% in women; p = 0.014) and aorto-ostial lesions (17% in men vs 29% in women; p = 0.009), whereas the SYNTAX score (23.5 ± 14.2 in men vs 17.1 ± 1.0 in women; p <0.001) was higher in men. Rates of device success (97% vs 98%; p = 1.000), technical success (90% vs 91%; p = 0.821) procedural success (90% vs 88%; p = 0.749), IVL-related complications (1% vs 2%; p = 0.362) and 1-year MACE rates (12% vs 17%; p = 0.456) were comparable. In conclusion, despite differences in clinical presentation and lesion types, IVL seems to be safe and effective for both sexes across various clinical and anatomical scenarios.