PDF(Pubmed)
Abstract：
UNASSIGNED: Calcified coronary lesions are a challenge for percutaneous coronary interventions (PCIs). Coronary intravascular lithotripsy (IVL) is a novel calcium modification technology approved for commercial use in February 2021, but little is known about its uptake in US clinical practice.
UNASSIGNED: We described trends in use of calcium modification strategies, variation in use across hospitals, and predictors of calcium modification and IVL use in PCI. We included National Cardiovascular Data Registry CathPCI Registry patients who underwent PCI between April 1, 2018, and December 31, 2022. We examined trends and hospital variation in calcium modification and IVL use. We used multivariate hierarchical logistic regression to identify predictors of calcium modification and IVL use at hospitals in 2022.
UNASSIGNED: Of 2,733,494 PCIs across 1676 hospitals over 4.75 years, 11.4% were performed with calcium modification. Coronary IVL use increased rapidly from 0% of PCIs in Q4 2020 to 7.8% of PCIs in Q4 2022, which was accompanied by an overall increase in use of all calcium modification strategies (11.1%-16.0%) during this period with a slight corresponding decrease in coronary atherectomy use (5.4%-4.4%). In 2022, there was wide variation in IVL use across hospitals (median, 3.86%; IQR, 0%-8.19%), with IVL being the most common calcium modification strategy in 48% of hospitals. The treating hospital was the strongest predictor of calcium modification (median odds ratio [OR], 2.49; 95% CI, 2.40-2.57) and IVL use (median OR, 2.89; 95% CI, 2.74-3.04).
UNASSIGNED: IVL has rapidly changed the landscape of calcium modification use for PCI, although there remains wide variation across hospitals.
UNASSIGNED: We described trends in use of calcium modification strategies, variation in use across hospitals, and predictors of calcium modification and IVL use in PCI. We included National Cardiovascular Data Registry CathPCI Registry patients who underwent PCI between April 1, 2018, and December 31, 2022. We examined trends and hospital variation in calcium modification and IVL use. We used multivariate hierarchical logistic regression to identify predictors of calcium modification and IVL use at hospitals in 2022.
UNASSIGNED: Of 2,733,494 PCIs across 1676 hospitals over 4.75 years, 11.4% were performed with calcium modification. Coronary IVL use increased rapidly from 0% of PCIs in Q4 2020 to 7.8% of PCIs in Q4 2022, which was accompanied by an overall increase in use of all calcium modification strategies (11.1%-16.0%) during this period with a slight corresponding decrease in coronary atherectomy use (5.4%-4.4%). In 2022, there was wide variation in IVL use across hospitals (median, 3.86%; IQR, 0%-8.19%), with IVL being the most common calcium modification strategy in 48% of hospitals. The treating hospital was the strongest predictor of calcium modification (median odds ratio [OR], 2.49; 95% CI, 2.40-2.57) and IVL use (median OR, 2.89; 95% CI, 2.74-3.04).
UNASSIGNED: IVL has rapidly changed the landscape of calcium modification use for PCI, although there remains wide variation across hospitals.
摘要：
■钙化冠状动脉病变是经皮冠状动脉介入治疗（PCI）的挑战。冠状动脉血管内碎石术（IVL）是一项新的钙修饰技术，于2021年2月批准用于商业用途，但在美国临床实践中对其吸收知之甚少。
■我们描述了使用钙改性策略的趋势，不同医院的使用差异，以及PCI中钙修饰和IVL使用的预测因子。我们纳入了2018年4月1日至2022年12月31日期间接受PCI的国家心血管数据注册CathPCI注册患者。我们检查了钙修饰和IVL使用的趋势和医院变化。我们使用多变量分层逻辑回归来确定2022年医院钙修饰和IVL使用的预测因素。
■在4.75年的时间里，共有1676家医院的2,733,494个PCI，11.4%进行钙改性。冠状动脉IVL的使用从2020年第四季度的PCIs的0％迅速增加到2022年第四季度的PCIs的7.8％，同时在此期间所有钙修饰策略的使用总体增加（11.1％-16.0％），冠状动脉粥样斑块切除术的使用略有相应减少（5.4％-4.4％）。2022年，各医院的IVL使用差异很大(中位数，3.86%；IQR，0%-8.19%），IVL是48％医院中最常见的钙修饰策略。治疗医院是钙修饰的最强预测因子(中位比值比[OR]，2.49；95%CI，2.40-2.57）和IVL使用（中位数OR，2.89；95%CI，2.74-3.04）。
■IVL迅速改变了PCI钙修饰的使用前景，尽管各医院之间仍然存在很大差异。
■我们描述了使用钙改性策略的趋势，不同医院的使用差异，以及PCI中钙修饰和IVL使用的预测因子。我们纳入了2018年4月1日至2022年12月31日期间接受PCI的国家心血管数据注册CathPCI注册患者。我们检查了钙修饰和IVL使用的趋势和医院变化。我们使用多变量分层逻辑回归来确定2022年医院钙修饰和IVL使用的预测因素。
■在4.75年的时间里，共有1676家医院的2,733,494个PCI，11.4%进行钙改性。冠状动脉IVL的使用从2020年第四季度的PCIs的0％迅速增加到2022年第四季度的PCIs的7.8％，同时在此期间所有钙修饰策略的使用总体增加（11.1％-16.0％），冠状动脉粥样斑块切除术的使用略有相应减少（5.4％-4.4％）。2022年，各医院的IVL使用差异很大(中位数，3.86%；IQR，0%-8.19%），IVL是48％医院中最常见的钙修饰策略。治疗医院是钙修饰的最强预测因子(中位比值比[OR]，2.49；95%CI，2.40-2.57）和IVL使用（中位数OR，2.89；95%CI，2.74-3.04）。
■IVL迅速改变了PCI钙修饰的使用前景，尽管各医院之间仍然存在很大差异。
