Intravascular Lithotripsy in Diabetic Patients Undergoing Percutaneous Coronary Intervention: Long-Term Outcomes from...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Diabetes mellitus (DM) is linked to worse outcomes after percutaneous coronary intervention (PCI).
• The effectiveness of intravascular lithotripsy (IVL) in diabetic patients undergoing PCI needs further definition.
• Diabetic patients often present with increased coronary calcification, posing challenges for PCI.

Purpose of the Study:

• To evaluate the safety and efficacy of IVL-assisted PCI in patients with and without DM.
• To compare major adverse cardiovascular events (MACE) and procedural outcomes between diabetic and non-diabetic patients.
• To assess the long-term performance of IVL in a high-risk diabetic population.

Main Methods:

• Analysis of the BENELUX-IVL registry, including 574 patients (193 with DM, 381 without).
• Comparison of procedural success, device success, and post-PCI lumen dimensions between groups.
• Evaluation of primary endpoint: MACE at 1 and 2 years (cardiovascular death, MI, TVR).
• Assessment of secondary endpoints: procedural complications and all-cause mortality.

Main Results:

• Procedural and device success rates were similar between diabetic and non-diabetic groups.
• Patients with DM had smaller post-PCI minimum lumen diameter and area.
• Thirty-day MACE was higher in diabetic patients (3.1% vs 0.3%), but 1- and 2-year MACE and mortality rates were comparable.
• Diabetes was not an independent predictor of mortality (aOR 1.51; p=0.17).

Conclusions:

• IVL-assisted PCI demonstrates safety and efficacy in diabetic patients.
• Long-term cardiovascular outcomes for diabetic patients treated with IVL-assisted PCI are comparable to non-diabetic patients.
• Higher early MACE in diabetics necessitates careful planning and follow-up, especially in Type 1 DM.