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

Background Moderate-to-severe coronary artery calcification (CAC) poses major challenges during percutaneous coronary intervention (PCI) and has historically been associated with procedural failure and adverse outcomes. However, its prognostic relevance in the era of contemporary intravascular imaging–guided PCI remains uncertain. This study aimed to evaluate the impact of moderate-to-severe CAC on 1-year clinical outcomes after IVUS-guided PCI. Methods This prospective, single-center study enrolled 914 patients who underwent IVUS-guided PCI between March and November 2023. CAC severity was classified by IVUS as none/mild or moderate-to-severe. After 1:1 propensity score matching, 576 patients (288 per group) were included. The primary endpoint was 1-year major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction, and target lesion revascularization. Results Moderate-to-severe CAC was present in 37.0% of patients. Before matching, the 1-year MACE rate was higher in patients with moderate-to-severe CAC than in those with none/mild CAC (9.5% vs. 4.2%; p = 0.001). In the matched cohort, this difference was attenuated and no longer statistically significant (9.4% vs. 6.3%; p = 0.162). Moderate-to-severe CAC was not significantly associated with MACE (HR 1.54; 95% CI 0.85–2.79; p = 0.157). Rates of stent thrombosis and target lesion revascularization were low and comparable. Conclusions Under routine IVUS-guided PCI, moderate-to-severe coronary calcification was associated with 1-year clinical outcomes comparable to those of no or mild calcification after adjustment.