Key result
Specialized lesion preparation and stenting strategies show no mortality or safety benefit in calcified coronary lesions.
Why the study?
Coronary arterial calcification impedes safe and predictable PCI, and although guidelines recommend calcium modification across several available techniques, the most optimal technique remains unclear.
Do specific percutaneous lesion preparation or stenting techniques reduce all-cause mortality and serious adverse events compared with conventional preparation or alternative techniques in patients undergoing PCI for moderately or severely calcified coronary lesions?
Meta-Analysis (n=8,453)
Do specific percutaneous lesion preparation or stenting techniques reduce all-cause mortality and serious adverse events compared with conventional preparation or alternative techniques in patients undergoing PCI for moderately or severely calcified coronary lesions?
Current randomised evidence demonstrates clinical equipoise among calcium modification and stenting strategies for calcified coronary lesions, as existing trials are largely underpowered to detect differences in mortality or serious clinical events.
Answers are grounded in this paper and cite their sources.
No preferred technique for calcified lesions; leaves open the need for larger, low-bias RCTs to detect outcome differences.
Background: Coronary arterial calcification impedes safe and predictable percutaneous coronary intervention (PCI), and guidelines recommend calcium modification. Several interventional techniques exist, but the most optimal technique remains unclear. The aim of this study was therefore to assess the effects of PCI strategies for calcified lesions on all-cause mortality and serious adverse events. Methods: A systematic review with meta-analysis and trial sequential analysis of randomised trials was conducted to compare any lesion preparation or stenting technique in patients undergoing PCI for moderately or severely calcified coronary lesions according to a published protocol. CENTRAL, MEDLINE, Embase and other sources were searched up to 8 May 2025. Results: Out of 7,172 identified records, 31 eligible trials (8,453 participants) assessed 16 lesion preparation techniques (4,392 participants) and five stenting/scaffold techniques (4,061 participants). Lesion preparation comparisons were generally underpowered, and all showed no effect on all-cause mortality or serious adverse events. For stenting strategies, meta-analysis and trial sequential analysis showed that an effect of stent polymer coating (bioresorbable, permanent or polymer-free) on all-cause mortality or serious adverse events could be rejected. Conclusion: For patients undergoing PCI for moderately or severely calcified coronary lesions, there appears to be no significant differences between lesion preparation techniques regarding all-cause mortality or serious adverse events. Current evidence is underpowered and of low certainty, highlighting the clinical equipoise between available calcium modification techniques and the necessity for adequately powered randomised trials.
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Kristensen et al. (2025) conducted a meta-analysis in Moderately or severely calcified coronary lesions undergoing percutaneous coronary intervention (PCI) (n=8,453). Specialised lesion preparation techniques (e.g., orbital atherectomy, rotational atherectomy, scoring/cutting balloons, lithoplasty, excimer laser) and contemporary drug-eluting stents/scaffolds vs. Conventional lesion preparation (standard therapy/balloons) or alternative lesion preparation/stenting techniques was evaluated on All-cause mortality and serious adverse events (ICH-GCP definition). Percutaneous lesion preparation and stenting techniques showed no significant differences in all-cause mortality or serious adverse events across 31 trials (n=8,453) of calcified coronary lesions.
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