Implementation of Intravascular Coronary Lithotripsy in the United States

Abstract

Background

Disparities in health care access persist in cardiovascular interventions. Coronary lithotripsy, a novel treatment for calcified coronary lesions, shows variability in utilization by sociodemographic factors.

Objectives

This study examines the impact of sex, race, income, and hospital characteristics on lithotripsy use in the United States.

Methods

Using the 2021 Nationwide Inpatient Sample, patients undergoing percutaneous coronary intervention were identified. Lithotripsy was defined by the International Classification of Diseases-10th Revision codes. Multivariable logistic regression assessed the impact of sociodemographic factors, adjusting for comorbidities and hospital characteristics. Outcomes were compared using propensity score matching, with P < 0.05 considered significant.

Results

Of 261,260 percutaneous coronary intervention patients, 1,000 (0.38%) underwent lithotripsy. Adjusted analyses revealed that women were less likely to receive lithotripsy than men (adjusted OR [aOR]: 0.65; 95% CI: 0.53-0.79; P < 0.001). African American patients had lower odds of receiving lithotripsy than Whites (aOR: 0.66; 95% CI: 0.48-0.93; P = 0.016). Medicaid patients were less likely to receive lithotripsy (aOR: 0.20; 95% CI: 0.11-0.36; P < 0.001) compared to Medicare beneficiaries. Higher-income quartiles increased odds of receiving lithotripsy compared to lower quartiles (aOR: 1.38-1.6; P < 0.05). Regional disparities were noted, with lower use in the South (aOR: 0.66; 95% CI: 0.47-0.94; P = 0.022).

Conclusions

Disparities in lithotripsy utilization persist, driven by sex, race, insurance status, income, and geographic region. These findings emphasize the need for targeted interventions to promote equitable access to advanced cardiovascular therapies. While some disparities may reflect differences in disease prevalence, persistent inequities in treatment allocation warrant further investigation.