Impact of cancer history on coronary calcification and clinical outcomes in intravascular ultrasound-guided percutaneous coronary intervention.

BACKGROUND

Cancer survivors have an elevated cardiovascular disease burden, yet the influence of cancer history on coronary calcification and outcomes following percutaneous coronary intervention (PCI) is not well characterized. This study investigated the association between cancer history and coronary calcification assessed by intravascular ultrasound (IVUS), and examined outcomes after IVUS-guided PCI.

METHODS

We retrospectively evaluated 450 patients with stable angina who underwent IVUS-guided PCI between January 2020 and March 2024 and stratified them into cancer ( n  = 110) and non-cancer ( n  = 340) groups. Coronary calcification was graded using an IVUS-derived calcium score. Major adverse cardiac and cerebrovascular events (MACCEs) were assessed during follow-up. Multivariate logistic and Cox regression analyses identified predictors of severe calcification (IVUS-calcium score ≥2) and MACCEs excluding cancer-related deaths. Furthermore, outcomes of rotational atherectomy for severely calcified lesions were examined.

RESULTS

Patients with a history of cancer had a high prevalence of moderate-to-severe calcification. Cancer history was independently associated with severe calcification (adjusted odds ratio: 2.32; 95% confidence interval: 1.43-3.77; P  < 0.001), but not with MACCEs excluding cancer-related deaths. An IVUS-calcium score ≥2 and impaired renal function were independently associated with MACCEs excluding cancer-related deaths. Among patients undergoing rotational atherectomy, clinical outcomes including MACCEs and target lesion revascularization were comparable between groups.

CONCLUSION

Cancer history was associated with a greater coronary calcification burden; however, clinical outcomes following IVUS-guided PCI showed no significant difference between patients with and without cancer. These findings suggest that appropriate IVUS-guided lesion assessment enable safe revascularization in this high-risk population.