Data Sheet 2_Residual risk persists in severely calcified lesions despite optimal stent expansion: a paradoxical finding from an IVUS-guided PCI cohort.pdf

Multivariable Cox regression using three prespecified adjustment models was performed.</p>Results<p>Over a median follow-up of 18.6 months, 57 patients (8.0%) experienced TVR and 122 (17.2%) experienced MACE. Post-PCI MSA (5.9 vs. 5.6 vs. 5.8 mm²; P = 0.286) and expansion index (0.89 vs. 0.88 vs. 0.88; P = 0.485) were comparable across groups, indicating acceptable acute stent expansion in severely calcified lesions.

Nevertheless, severe CAC remained independently associated with increased TVR risk in the primary analysis (adjusted hazard ratio [aHR] 2.51, 95% CI 1.33–4.74, P = 0.005), persisting after extended adjustment (aHR 2.61, P = 0.007) and after excluding rotational atherectomy (RA) cases (aHR 2.29, P = 0.018). The association between severe CAC and MACE was more modest (aHR 1.77, P = 0.014) and attenuated after extended adjustment (aHR 1.49, P = 0.119).

Calcified nodules, present in 64.5% of severe CAC lesions, independently predicted TVR (aHR 3.04, P < 0.001). Mild CAC showed no significant risk elevation.</p>Conclusion<p>Severe CAC identifies a subgroup at persistently elevated risk for repeat revascularization despite achieving stent expansion comparable to non-calcified lesions, challenging the conventional paradigm linking calcification to adverse events solely through underexpansion.</p>