Predicting Temporal Trends and Hospital-Level Variation in Calcium Modification Strategies Adoption in Percutaneous Coronary Intervention

Background: The adoption patterns of novel cardiovascular interventional technologies significantly impact patient care and health care resource allocation. This study analyzes and projects the adoption trends of intravascular lithotripsy (IVL) compared to coronary atherectomy (CA). Objectives: The objective of the study was to investigate the predicted utilization trends of various calcium modification strategies by year 2035. Methods: Leveraging data from multiple U.S.-based registries (2009-2022), we developed Monte Carlo simulations (n = 100,000 simulated iterations) to model adoption trends and hospital-level variations. Logistic growth models were used to project technology adoption rates through 2035. Results: IVL showed rapid adoption with a projected terminal rate of 32.41% by year 2035 (95% CI: 28.76% to 36.06%) and mean annual growth of 2.5% (95% CI: 2.1% to 2.9%). CA (rotational and orbital) adoption is projected to reach 4.5 to 5.5% by 2035 (10% to 90% CI: 3.8% to 6.2%). Hospital-level analysis revealed increasing variability in adoption patterns, with high-volume centers (>10% CA use) increasing from 8.6% (2020) to 29.6% (2035). Conclusions: This analysis demonstrates divergent adoption patterns between IVL and CA, with IVL showing more rapid uptake. The findings highlight important implications for clinical practice, resource allocation, and health care policy.