Coronary artery calcification: Contemporary diagnosis from invasive imaging to percutaneous treatment

Coronary artery calcification (CAC) represents a significant challenge in contemporary interventional cardiology, substantially affecting percutaneous coronary intervention (PCI) outcomes. Understanding the distinct morphological patterns of calcium deposition, from microcalcification to macrocalcific nodules, including eruptive and non-eruptive lesions, is crucial for optimizing procedural planning and improving clinical outcomes. Recent advances in artificial intelligence-assisted imaging interpretation and novel calcium modification techniques have expanded our therapeutic armamentarium. This review examines the pathophysiological mechanisms underlying CAC, epidemiological patterns, contemporary diagnostic approaches with emphasis on invasive imaging modalities, and current percutaneous treatment strategies. We provide an evidence-based framework for managing calcified coronary lesions in modern interventional practice.