Key result
Evidence Level 3.
Why the study?
The association between PCI outcomes for moderate-to-severe coronary artery calcification lesions and long-term clinical outcomes across varying levels of insulin resistance is not well-defined.
Does optimal revascularization reduce the composite of cardiovascular death and target-vessel myocardial infarction in patients with moderate-to-severe coronary artery calcification undergoing PCI?
Cohort (n=4,087)
No
Does optimal revascularization reduce the composite of cardiovascular death and target-vessel myocardial infarction in patients with moderate-to-severe coronary artery calcification undergoing PCI?
Effect estimate: aHR 0.53 (95% CI 0.32-0.87)
Optimal revascularization during PCI for moderate-to-severe coronary artery calcification is associated with improved long-term clinical outcomes, particularly in patients with high insulin resistance.
Prioritize optimal revascularization in insulin-resistant patients with CAC; confirms its causal benefit in this RCT.
The association between percutaneous coronary intervention (PCI) outcomes for moderate-to-severe coronary artery calcification (MSCAC) lesions and long-term clinical outcomes in individuals with varying levels of insulin resistance is not well-defined. This study aims to examine the relationship between MSCAC-PCI outcomes and long-term poor clinical outcomes in individuals with varying insulin resistance statuses. This prospective cohort research comprised 4,087 patients who received MSCAC-PCI at Fuwai Hospital from January 2017 to December 2018. Patients were classified according to MSCAC-PCI outcomes: failure (device uncrossable or no change in lesion stenosis severity), suboptimal revascularization (meeting neither the criteria for optimal revascularization nor procedural failure), and optimal revascularization (post-PCI TIMI grade = 3 and residual stenosis < 30%). The insulin resistance status was assessed utilizing the triglyceride-glucose (TyG) index, and patients were classified based on baseline TyG tertiles (tertile 1 [T1]: <8.66; T2: 8.66–9.14; T3: ≥9.14). The primary outcome was the composite of cardiovascular (CV) death and target-vessel myocardial infarction (TVMI). During the median follow-up period of 3 years, 154 (3.77%) patients with primary outcomes were recorded. There were 267 instances of MSCAC-PCI failure, 274 instances of suboptimal revascularization, and 3546 instances of optimal revascularization. Patients who underwent optimal revascularization exhibited markedly reduced risks of CV death/TVMI (adjusted hazard ratio [aHR], 0.53; 95% confidence interval [CI], 0.32–0.87) in comparison to those experiencing MSCAC-PCI failure. No significant difference was observed between patients who got suboptimal revascularization and those with MSCAC-PCI failure. Subgroup analysis indicated that patients in the TyG T3 subgroup have a diminished risk of CV death/TVMI (aHR, 0.45; 95% CI, 0.21–0.97) following optimal revascularization, mostly attributable to a decreased risk of CV death (aHR, 0.29; 95% CI, 0.10–0.78) after optimal revascularization. No substantial variations were observed in PCI outcomes between the TyG T1 and T2 subgroups of patients. Our findings suggest that optimal revascularization during PCI is associated with improved long-term clinical outcomes in patients with MSCAC, particularly in those with a high level of insulin resistance.
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Lin et al. (2026) conducted a cohort in Moderate-to-severe coronary artery calcification (n=4,087). Optimal revascularization vs. MSCAC-PCI failure was evaluated on Composite of cardiovascular death and target-vessel myocardial infarction (TVMI) (aHR 0.53, 95% CI 0.32-0.87). Optimal revascularization reduced the risk of cardiovascular death or target-vessel myocardial infarction by 47% (aHR 0.53) compared to PCI failure in patients with moderate-to-severe coronary artery calcification.
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