Disparities in the Use of Atherectomy and Intravascular Lithotripsy for Percutaneous Coronary Intervention

Atherectomy and intravascular lithotripsy (IVL) facilitate percutaneous coronary intervention (PCI) in calcified coronary disease, and use of these technologies is associated with greater luminal gain and superior intervention success. As atherectomy/IVL gain more widespread acceptance, it is important to understand whether their use differs across levels of social deprivation.

Within the National Cardiovascular Data Registry CathPCI Registry, we identified 310,124 patients who had a PCI for severely calcified lesions between 2018 and 2023. For each patient, we determined their social deprivation index (SDI) based on residential zip codes. The SDI is a composite measure of area-level social deprivation, with higher values correlating to greater deprivation. Hierarchical logistic regression models evaluated the association of SDI with use of atherectomy/IVL.

Mean age was 70.9 ± 10.6 years, 69.4% were men, and 82.3% were of White race. Atherectomy/IVL was used in 33.0% of PCIs in severely calcified arteries. There was an inverse, graded relationship between SDI and atherectomy/IVL use. These differences were only partially attenuated after adjusting for patient and PCI characteristics. Compared with those residing in neighborhoods with the lowest quartile of social deprivation, those in the third and fourth quartiles of social deprivation were 10% (odds ratio, 0.90; 95% CI, 0.88-0.92; P < .001) and 8% (odds ratio, 0.92; 95% CI, 0.90-0.94; P < .001), respectively, less likely to have atherectomy/IVL used during PCI.

In the United States, greater social deprivation was associated with lower rates of atherectomy/IVL during PCI for severely calcified coronary artery stenoses, highlighting potential disparities in use of these technologies.