Jose Manuel Montero-Cabezas

Background: The United Kingdom–British Cardiovascular Intervention Society complex high‐risk indicated percutaneous coronary intervention (UK‐BCIS CHIP) score was developed to identify patient‐ and procedural factors to predict short‐term adverse outcomes in patients undergoing high risk percutaneous coronary intervention (PCI). The performance of the UK‐BCIS CHIP score in a patient population treated with intravascular lithotripsy (IVL) for severe coronary calcification remains unknown. Aims: To evaluate the prognostic performance of the UK‐BCIS CHIP score in patients undergoing IVL‐assisted PCI for severe coronary calcification, and to assess procedural and 1‐year clinical outcomes across CHIP score categories. Methods: This international, multicenter, prospective study included consecutive patients undergoing IVL‐assisted PCI between May 2019 and December 2025 from the BENELUX‐IVL registry. Patients were stratified according to UK‐BCIS CHIP score categories (0, 1–2, 3–4, and ≥ 5). The primary endpoint was 1‐year major adverse cardiac events (MACE), defined as a composite of cardiovascular death, non‐fatal myocardial infarction, or clinically driven target vessel revascularization. Secondary endpoints included all‐cause mortality, procedural outcomes, and periprocedural complications. Discrimination of the UK‐BCIS CHIP score was assessed using the AUC for in‐hospital events and the Harrell's C‐index for 1‐year outcomes. Results: A total of 911 patients were included. Higher UK‐BCIS CHIP scores were associated with increased clinical comorbidity, lesion complexity, and procedural intensity. Procedural, device, and technical success rates were comparable across UK‐BCIS CHIP score categories (85.1%, 94.4%, and 85.7% overall; p = 0.850, p = 0.813, and p = 0.781, respectively). Complications requiring intervention occurred in 5.5% of patients and did not differ significantly across CHIP score categories ( p = 0.347). The 1‐year cumulative incidence of MACE, accounting for all‐cause death as a competing risk, did not differ significantly across UK‐BCIS CHIP score categories (Gray's test p = 0.53). Conclusion: In IVL‐assisted PCI, the UK‐BCIS CHIP score effectively identifies patients with increased clinical and procedural complexity but shows limited discrimination for mid‐term ischemic outcomes. IVL‐assisted PCI is safe and effective across the full spectrum of CHIP risk, while long‐term prognosis appears primarily driven by underlying comorbidity burden.

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