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Minerva Cardiology and Angiology 2021 Nov 11

DOI: 10.23736/S2724-5683.21.05681-7


lingua: Inglese

Comparative study of costs and resource utilisation of rotational atherectomy versus intravascular lithotripsy for percutaneous coronary intervention

Shafeer RISHAD 1, 2, Margaret McENTEGART 2, Thomas J. FORD 2, 3, Carlo DI-MARIO 4, Jean FAJADET 5, Mitchell LINDSAY 2, Stuart WATKINS 2, Hany ETEIBA 2, Richard BROGAN 2, Richard GOOD 2, Keith G. OLDROYD 1, 2

1 University of Glasgow, Glasgow, UK; 2 West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; 3 Faculty of Medicine, University of Newcastle NSW, Newcastle, Australia; 4 Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; 5 Clinique Pasteur, Toulouse, France


BACKGROUND: Intravascular lithotripsy (IVL) is a novel alternative to rotational atherectomy (RA) for the modification of heavily calcified coronary stenoses prior to percutaneous coronary intervention (PCI). We compare the real-world resource utilisation and associated costs of PCI with adjunctive RA and IVL.
METHODS: We compared the resource utilisation, in-lab consumable costs and procedural data of 120 patients who underwent PCI with IVL from the Disrupt-CAD II study (NCT03328949) to 60 patients who underwent PCI with RA at the Golden Jubilee National Hospital, Glasgow. The RA patients were consecutive and selected on the basis of being deemed suitable for IVL by an independent interventional cardiologist experienced in the use of both techniques.
RESULTS: PCI with IVL was associated with significantly lower costs than PCI with RA (mean difference £398 [95% CI, £181-£615]; p<0.001). Considering between-group differences, the IVL group used 4.02 fewer balloons (p<0.001), 3.03 fewer guidewires (p<0.001), 0.52 fewer guide catheters (p=0.001), 0.22 fewer guide extensions (p=0.004) and 1.03 fewer drug eluting stents (DES) (p<0.001) per case than the RA group. The IVL group had shorter procedural duration (mean difference 13.3 min [95% CI, 3.6-23.0]; p=0.008) but longer fluoroscopy times (mean difference 4.4 min [95% CI, 1.7-7.1]; p=0.002).
CONCLUSIONS: In this indirect comparison, we found that the higher initial device costs of IVL may be offset by a lower overall resource utilisation. Further research is required to confirm this, and future randomised trials should include a formal health economic analysis.

KEY WORDS: Percutaneous coronary intervention; Coronary artery disease; Atherectomy; Lithotripsy

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