Impact of moderate-to-severe coronary calcification on 1-year clinical outcomes after IVUS-guided PCI

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Moderate-to-severe coronary artery calcification (CAC) presents challenges in percutaneous coronary intervention (PCI), historically linked to procedural failure and adverse outcomes.
• The prognostic significance of severe CAC in the context of modern intravascular imaging-guided PCI is not well-established.

Purpose of the Study:

• To assess the impact of moderate-to-severe CAC on 1-year clinical outcomes following intravascular ultrasound (IVUS)-guided PCI.
• To determine if severe CAC remains an independent predictor of adverse events in the era of advanced PCI techniques.

Main Methods:

• A prospective, single-center study included 914 patients undergoing IVUS-guided PCI.
• Coronary artery calcification (CAC) severity was assessed using IVUS and categorized as none/mild or moderate-to-severe.
• One-to-one propensity score matching created a cohort of 576 patients (288 per group) to compare outcomes.

Main Results:

• Moderate-to-severe CAC was identified in 37.0% of patients.
• Initially, 1-year major adverse cardiac events (MACE) were higher in the severe CAC group (9.5% vs. 4.2%, p=0.001).
• After propensity score matching, the MACE difference was not statistically significant (9.4% vs. 6.3%, p=0.162), and severe CAC was not a significant predictor of MACE (HR 1.54; 95% CI 0.85-2.79; p=0.157).

Conclusions:

• Routine IVUS-guided PCI is associated with comparable 1-year clinical outcomes for patients with moderate-to-severe CAC versus those with no or mild calcification.
• Intravascular ultrasound guidance may effectively manage the risks associated with significant coronary calcification during PCI.