Impact of Plaque Morphology on Drug-Coated Balloon Treatment Outcomes for Coronary Calcified Lesions ― An Optical Coherence Tomography Analysis ―

Background: Percutaneous coronary intervention (PCI) for calcified coronary lesions without stent implantation remains a challenging therapeutic strategy. The efficacy of drug-coated balloon (DCB) therapy in relation to specific calcified plaque morphologies has not been previously investigated. Methods and Results: We conducted a retrospective analysis of 150 lesions (136 patients) who underwent optical coherence tomography (OCT)-guided PCI using DCB for angiographically moderate-to-severe calcified lesions. Based on the OCT findings, target lesions were categorized into 3 groups: superficial calcific sheet (SC) group; calcific protrusion (CP) group; and eruptive calcified nodule (eCN) group. Long-term clinical outcomes, including clinically driven target lesion revascularization (CD-TLR), myocardial infarction (MI), cardiac death, and the composite endpoint of major adverse cardiovascular events (MACE), were assessed over a median follow up of 2.6 years. No significant differences in rates of CD-TLR, MI, cardiac death, or MACE were observed between the SC and CP groups. In contrast, the eCN group showed significantly higher incidences of MI (P