Optimal Stent Expansion Indices for Predicting Outcomes in PCI of Calcified Coronary Lesions

Background There is a lack of established stent expansion criteria to predict long-term outcomes following percutaneous coronary intervention (PCI) in calcified coronary lesions. Aims The aim of this study was to evaluate the relationship between various stent expansion indices and clinical outcomes including target lesion failure (TLF) following PCI in patients with calcified coronary lesions. Methods This study was a retrospective single-center study. Patients with native calcified coronary artery lesions treated with imaging guided PCI and the availability of final intravascular ultrasound or optical coherence tomography images were included. The association between eight stent expansion indices and long-term TLF was evaluated. Results A total of 280 lesions from 221 patients were analyzed. The median patient age was 71 years (Interquartile Range: 63–77), and 155 (70.1%) were male. Of the eight stent expansion indices, only the minimum stent area (MSA) > 100% of distal reference lumen area (HR 0.29; 95% CI 0.13–0.65; p = 0.003), MSA > 90% of distal reference area (HR 0.45; 95% CI 0.25–0.84; p = 0.012) and MSA > 5.0 mm 2 or > 90% of distal reference lumen area criteria (HR 0.41; 95% CI 0.22–0.75; p = 0.004) demonstrated a significant association with lower risk of long-term TLF. Conclusions In the present retrospective analysis, a final MSA > 100% relative to the distal reference lumen area and MSA > 5.0 mm 2 or > 90% of distal reference lumen area criteria were most accurate in predicting TLF after PCI of calcified coronary lesions.