Abstract Body (Do not enter title and authors here): Background: Calcified left main disease is a high-risk and procedurally complex subset of coronary artery disease. So, adequate lesion preparation before stenting is crucial in achieving a favorable outcome. We performed a meta-analysis to compare the safety of intravascular lithotripsy (IVL) and rotational atherectomy (RA) in preparation of calcified left main coronary artery disease.

Hypothesis: We hypothesize that there are no significant differences in angiographic and in-hospital outcomes between RA and IVL while treating calcified left main coronary disease.

Methods: We systematically searched PubMed, Embase, and Cochrane databases until May 2024 for studies comparing IVL and RA in calcified left main coronary disease. A random-effects model was used to pool risk ratios (RR) with corresponding 95% confidence intervals (CI). Statistical analyses were performed using software R and heterogeneity was assessed using I² statistics.

Results: We included 3 studies comprising 276 patients undergoing PCI for calcified left main disease, of whom 109 (39.5%) underwent lesion preparation with IVL. The mean age was 72.9 years and 73.1% were males. In the pooled analysis, there were no significant differences between the IVL and RA treated groups in terms of in-hospital mortality (RR 0.30; 95% CI 0.08 to 1.13, p=0.07, I²=0%; Figure 1A) and in-hospital myocardial infarction (RR 0.85; 95% CI 0.17 to 4.11, p=0.83, I²=0%; Figure 1B). There was also no significant difference in angiographic outcomes such as coronary perforation (RR 0.56; 95% CI 0.15 to 2.04; p=0.37, I²=0%; Figure 2A) and slow-flow/no-reflow (RR 1.43; 95% CI 0.22 to 9.51; p=0.70, I²=0%; Figure 2B).

Conclusion: This meta-analysis showed that both IVL and RA were comparable in terms of in-hospital and angiographic outcomes while treating calcified left main coronary disease.