Intravascular lithotripsy (IVL) is increasingly used to modify calcified coronary lesions before stent implantation, although outcome differences between patients with and without diabetes remain incompletely characterized. A single-center analysis presented at EuroPCR 2026 evaluated procedural characteristics and follow-up outcomes after IVL-assisted percutaneous coronary intervention (PCI) in patients with calcified coronary artery disease (CAD).

The study included 295 calcified lesions treated with IVL in 278 consecutive patients between 2018 and 2026, including 107 patients (36.3%) with diabetes. Patients with diabetes had a higher burden of baseline comorbidities, including hypertension, dyslipidemia, chronic kidney disease, and dialysis dependence.

Findings

• Target lesion revascularization (TLR) occurred in 22 cases (7.5%) during a mean follow-up of 401 days.
• TLR occurred in 10 patients without diabetes, 7 patients with non-insulin-treated diabetes, and 5 patients with insulin-treated diabetes.
• Diabetes was associated with higher TLR risk in univariate analysis (hazard ratio [HR] 2.98; p = 0.012).
• Insulin-treated diabetes was also associated with higher TLR risk (HR 3.71; p = 0.012).
• Diabetes remained independently associated with TLR across multivariable models (HR range 2.66–2.89; p = 0.015–0.028).
• TLR-free survival rates were 94.7% in patients without diabetes, 90.9% in patients with diabetes, and 83.3% in patients with insulin-treated diabetes (log-rank p = 0.007).

Diabetes, particularly insulin-treated diabetes, was associated with higher TLR risk after IVL-assisted PCI despite similar procedural characteristics between groups.