Procedural and Clinical Outcomes of Coronary Intravascular Lithotripsy in Patients With Impaired Renal Function: A Multicenter Retrospective Study

Chronic kidney disease (CKD) is a prevalent comorbidity in patients undergoing percutaneous coronary intervention (PCI), yet its impact on outcomes following intravascular lithotripsy (IVL) remains insufficiently studied. This study evaluated procedural and long-term outcomes of IVL-assisted PCI in patients with renal insufficiency compared to those with normal renal function. From the BENELUX-IVL registry (May 2019–September 2024), 558 patients were included in a retrospective multicenter analysis. Renal insufficiency was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² using the CKD-EPI formula. The primary endpoint was major adverse cardiovascular events (MACE) at one and two years of follow-up. Secondary endpoints included procedural, device, and technical success, as well as all-cause mortality. Multivariable logistic regression was used to identify independent predictors of mortality. A total of 586 lesions were treated in 558 patients: 190 (32.4%) with renal insufficiency and 396 (67.6%) with normal renal function. One-year MACE occurred in 14 (13.3%) versus 28 (10.9%) patients (p = 0.80), and between year one and two in 4 (5.6%) versus 5 (2.8%) patients (p = 0.46). Procedural success was similar between groups (88.6% versus 88.7%; p = 0.97). All-cause mortality was higher in the renal insufficiency group (n = 32, 18.2% versus n = 44, 11.5%; p = 0.03). On multivariable analysis, eGFR was independently associated with mortality (OR 0.98; 95% CI 0.97–1.00; p = 0.020). In conclusion, IVL-assisted PCI resulted in similar procedural and MACE outcomes regardless of renal function, although mortality was significantly higher in patients with renal insufficiency.