35 Intravascular lithotripsy-assisted PCI for severe calcific coronary disease: evaluating the impact on quality of life and outcomes
Bibliographic record
Abstract
Introduction Severe coronary artery calcification (CAC) in patients undergoing percutaneous coronary intervention (PCI) is a common cause of procedural complications, lack of success, and stent failure. In this study we examine the utility of a novel technique to deal with this problem: intravascular lithotripsy (IVL) using the ‘Shockwave’ device. Methods A retrospective single centre study was conducted of consecutive patients treated with coronary IVL between January and October 2020. Baseline demographics were obtained from electronic patient records and SYNTAX scores were calculated from index coronary angiograms. Procedural success was verified by independent review of the angiogram and defined as (1) adequate stent expansion, (2) no significant residual stenosis and (3) TIMI III flow in all major branches. Target lesion revascularisation (TLR) was defined as any unplanned repeat PCI of the target lesion or bypass of the target vessel performed for in-stent restenosis (ISR) or other complication of the target lesion. Clinical outcomes including Canadian Cardiovascular Society (CCS) angina classification were assessed at virtual clinical follow-up. Results 47 patients were treated with IVL during the study period. Baseline demographics and procedural characteristics are seen in tables 1 and 2, respectively. All patients had circumferential or near-circumferential calcium as determined by coronary angiography ± intracoronary imaging. 57% had treatment of a de novo lesion, 32% had PCI to a previously placed under-expanded stent and 11% had severely calcified ISR. Procedural success was high (94%), however, reasons for failure/abandonment included: (i) intra-procedural ischaemia with significant residual stenosis, (ii) prolonged procedural time, ischaemia and resistant stent under-expansion and (iii) prolonged procedural time, dissection with no-reflow, in the setting of a chronic total occlusion (CTO). Complications Included Coronary dissection (13%) of which the majority were successfully treated with conservative measures and coronary perforation (2%) which was treated with prolonged balloon inflation. At a mean follow up of 10 months, 23% underwent planned/staged-PCI, 4% underwent CABG and there were 2 (4%) deaths. There was a 51% reduction in CCS angina class from 2.9 (prior to IVL) to 1.4 (post IVL), p<0.00001. Conclusions The use of coronary IVL is a very effective percutaneous therapy for severe CAC. This cohort shows high procedural success with IVL and a significant reduction in CCS angina class at follow-up.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".