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Background: To date, claims data have not been used to study outcome differences between low and high socioeconomic status (SES) patients surviving ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in the Netherlands. Aim: To evaluate STEMI and NSTEMI care among patients with low and high SES in the referral area of three Dutch percutaneous coronary intervention (PCI) centres, using claims data as a source. Methods: STEMI and NSTEMI patients treated in 2015–2017 were included. Patients' SES scores were collected based on their postal code via an open access government database. In patients with low (SES1) and high (SES4) status, revascularisation strategies and secondary prevention medication were compared. Results: A total of 2065 SES1 patients (age 68 ± 13 years, 58% NSTEMI) and 1639 SES4 patients (age 68 ± 13 years, 63% NSTEMI) were included. PCI use was lower in SES1 compared to SES4 in both STEMI (80% vs 84%, p < 0.012) and NSTEMI (42% vs 48%, p < 0.002) patients. Coronary artery bypass grafting was performed more often in SES1 than in SES4 in both STEMI (7% vs 4%, p = NS) and NSTEMI (11% vs 7%, p < 0.001) patients. Optimal medical therapy use in STEMI patients was higher in SES1 compared to SES4 (52% vs 46%, p = 0.01) but comparable among NSTEMI patients (39% vs 40%, p = NS). One-year mortality was comparable in SES1 and SES4 patients following STEMI (14% vs 16%, p = NS) and NSTEMI (10% vs 11%, p = NS). Conclusion: Combined analysis of claims data and area-specific socioeconomic statistics can provide unique insight into how to improve myocardial infarction care for low and high SES patients. [ABSTRACT FROM AUTHOR]

Intravascular lithotripsy (IVL) has been established as a safe and effective treatment for coronary artery calcification (CAC). This study aimed to evaluate gender-related differences in the treatment with IVL in a real-world, all-comers international registry. Patients who underwent IVL between May 2019 and February 2024 were enrolled from the BENELUX-IVL registry. Patients were divided into men and women groups. Efficacy end points included device success (delivery of the IVL balloon across the target lesion and administration of therapy without related complications), technical success (thrombolysis in myocardial infarction 3 flow and residual stenosis <30% by quantitative coronary analysis and/or fluoroscopically) and procedural success (composite of technical success with absence of in-hospital major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). Safety end points were IVL-related complications and MACE at 1-year follow-up. 454 patients (73 ± 9.0 years) were treated with IVL, comprising 342 men (75%) and 112 women (25%). More women presented with acute coronary syndrome (41% in men vs 54% in women; p = 0.014) and aorto-ostial lesions (17% in men vs 29% in women; p = 0.009), whereas the SYNTAX score (23.5 ± 14.2 in men vs 17.1 ± 1.0 in women; p <0.001) was higher in men. Rates of device success (97% vs 98%; p = 1.000), technical success (90% vs 91%; p = 0.821) procedural success (90% vs 88%; p = 0.749), IVL-related complications (1% vs 2%; p = 0.362) and 1-year MACE rates (12% vs 17%; p = 0.456) were comparable. In conclusion, despite differences in clinical presentation and lesion types, IVL seems to be safe and effective for both genders across various clinical and anatomical scenarios., Competing Interests: Declaration of competing interest The Department of Cardiology of the Leiden University Medical Center received unrestricted research grants from Abbott Vascular, Bayer, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare (Little Chalfont, United Kingdom), and Medtronic. B.E.P.M. Claessen reports relations with Sanofi, Philips, Amgen, Boston Scientific Corp, and AbioMed Inc. that include consulting or advisory. TNE Vossenberg received consultancy fees from Boston Scientific and Cardiac Dimensions. Dr Kefer has served as a proctor for Abbott. F. van der Kley received consultancy fees from Edwards Lifesciences and Abbott Vascular. J.M. Montero received a research grant from Shockwave Medical and speaker fees from Abiomed, Boston Scientific, and Penumbra Inc. The remaining authors have no conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Intravascular lithotripsy (IVL) is increasingly used for treatment of coronary artery calcification. This study aimed to evaluate contemporary utilisation patterns, safety and efficacy of IVL in an unselected real-world patient cohort., Methods: We included 454 patients undergoing IVL from May 2019 to February 2024 across seven centres in two European countries. Key endpoints included device success, technical success, procedural success, IVL-related complications and major adverse cardiovascular events (MACE) at 1-year follow-up., Results: The cohort (mean age 73±9 years, 75% male) had a mean SYNTAX Score of 22.0±13.6. Device, technical and procedural success were achieved in 98%, 91% and 89% of patients, respectively. IVL-related complications occurred in six patients (1%). At 1-year follow-up, MACE was observed in 37 patients (13%). Over time, IVL use increased in patients with acute coronary syndrome (p=0.004) and in combination with intracoronary imaging (p=0.002), while use of other calcium modification devices decreased (p=0.034)., Conclusion: In this real-world registry, IVL demonstrated efficacy across diverse clinical and anatomical settings. High success rates, low complication rates and MACE rates were observed acutely and at 1-year follow-up. Utilisation patterns evolved over time, with increased adoption in acute scenarios and alongside intracoronary imaging., Competing Interests: Competing interests: The Department of Cardiology of the Leiden University Medical Center received unrestricted research grants from Abbott Vascular, Bayer, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. BEPMC reports relations with Sanofi, Philips, Amgen, Boston Scientific and Abiomed that include consulting or advisory. JK has served as proctor for Abbott. FvdK received consultancy fees from Edwards Lifesciences and Abbott Vascular. JMM-C received a research grant from Shockwave Medical and speaker fees from Abiomed, Boston Scientific and Penumbra., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)