Risk Profile and Prognostic Implications of Percutaneous Coronary Intervention Procedure Failure in Patients With Moderate-to-Severe Coronary Artery Calcification.

BACKGROUND

Arterial calcification is an important characteristic of vascular aging. Risk factors and clinical outcomes of percutaneous coronary intervention (PCI) procedure failure in patients with moderate-to-severe coronary artery calcification (MSCAC) have not been adequately assessed. We aimed to analyze the characteristics, risk factors, and long-term clinical outcomes for patients with MSCAC with PCI procedure failure.

METHODS

We analyzed 26253 patients undergoing PCI at Fuwai Hospital between January 2017 and December 2018. Procedure failure was defined as residual stenosis ≥ 50%, severe angiographic complications, in-hospital death, or in-hospital myocardial infarction (MI). The primary endpoint was CV events, including CV death, nonfatal MI, and nonfatal stroke.

RESULTS

During a median 3-year follow-up, 613 CV events were recorded. The incidence of PCI procedure failure for MSCAC patients was 10.96%. Compared with non-MSCAC patients, the multivariable-adjusted hazard ratio (aHR) for CV events was 2.38 (95% CI: 1.65-3.44) for MSCAC with PCI failure subjects, while no significant difference could be found between non-MSCAC patients and MSCAC with PCI success patients. MSCAC patients with PCI procedure failure showed an increased risk of CV events (aHR: 2.16; 95% CI: 1.39-3.38) than those with procedure success. Application of intravascular ultrasound and rotational atherectomy were independent protective factors for the occurrence of MSCAC-PCI procedure failure in patients with severe calcification.

CONCLUSIONS

MSCAC patients with PCI procedure failure showed unfavorable long-term clinical outcomes compared with those with PCI procedure success. IVUS and rotational atherectomy could reduce the risk of PCI procedure failure occurrence.