The introduction of coronary intravascular lithotripsy (IVL), a novel calcium modification technology, has had a significant impact on the trends in calcium modification strategies used during PCI, although wide variation across hospitals remains, according to a recent study published in JSCAI.

Neel M. Butala, MD, MBA, et al., used data from the ACC’s CathPCI Registry from April 1, 2018, through Dec. 31, 2022, including 2,733,494 PCI procedures across 1,676 hospitals. They focused on the trends and hospital variation in calcium modification and IVL use.

Results showed that 11.4% of all PCIs analyzed used calcium modification. Coronary IVL use increased from 0% of PCIs in the fourth quarter of 2020 to 7.8% in the fourth quarter of 2022, corresponding with a general increase in calcium modification strategies (11.1% to 16%) and slight decrease in coronary atherectomy use (5.4% to 4.4%) during the same period.

The authors noted wide variation for IVL use among hospitals in 2022 (median, 3.86%; IQR, 0%-8.19%), and IVL was the most common calcium modification strategy in 48% of hospitals. When looking at predictors of calcium modification and IVL use, treating hospital was identified as the strongest for both (median odds ratio [OR], 2.49, 95% CI, 2.40-2.57; median OR, 2.89, 95% CI, 2.74-3.04, respectively).

The authors also found that calcium modification was less likely among women and Black patients and IVL use was less likely among women and Black, Asian or Hispanic patients, despite adjusting for clinical, lesion and hospital characteristics.

“These results may reflect underlying differences in the prevalence and characteristics of calcified lesions in these demographic subgroups that warrant different treatment strategies…” write the authors. “It is possible that differences could also reflect possible disparities in the use of calcium modification for PCI and in the initial rollout of IVL.”