Key result
Advanced calcium-modification tools improve minimal stent area by ~0.87 mm² vs. noncompliant balloons without clinical benefit.
Why the study?
Calcified coronary lesions increase PCI failure risk, and comparative investigations among available calcium-modification strategies remain scanty despite several randomized trials.
Do calcium-modification strategies improve minimal stent area and clinical outcomes compared to noncompliant balloons in patients undergoing PCI of calcified coronary lesions?
Meta-Analysis (n=4,855)
Yes
Do calcium-modification strategies improve minimal stent area and clinical outcomes compared to noncompliant balloons in patients undergoing PCI of calcified coronary lesions?
Answers are grounded in this paper and cite their sources.
Calcium-modification strategies, particularly balloon- and rotational atherectomy-based techniques, improve minimal stent area compared to noncompliant balloons in calcified coronary lesions, but this mechanical advantage does not translate into improved short-to-medium term clinical outcomes.
Introduction and Objectives Calcified coronary lesions are associated with an increased risk of percutaneous coronary intervention (PCI) failure. Despite the availability of several calcium‐modification strategies and randomized trials evaluating their efficacy, comparative investigations remain scanty. The aim of the present analysis is to assess the comparative performance of calcium‐modification strategies in patients undergoing PCI of calcified coronary lesions. Methods We conducted a systematic search for randomized trials evaluating calcium‐modification strategies in patients undergoing PCI. Random‐effects network meta‐analyses were performed. The primary outcome was minimal stent area (MSA). Secondary outcomes included all‐cause death and stent thrombosis. Results Twenty‐two trials enrolling 4855 patients were included. Compared to calcium modification with noncompliant balloons, the use of cutting/scoring balloon (mean difference: 0.81 mm 2 , 95% confidence interval: [0.36, 1.27]; p = 0.001), super high‐pressure balloon (SHPB, 0.95 mm 2 [0.18, 1.72]; p = 0.016), intravascular lithotripsy (IVL, 0.87 mm 2 [0.40, 1.34]; p < 0.001), rotational atherectomy (RA, 0.90 mm 2 [0.30, 1.50]; p = 0.003), and RA plus cutting balloon (1.24 mm 2 [0.46, 2.02]; p = 0.002) led to larger MSA. According to a network ranking analysis, RA, SHPB, and IVL were possibly the best treatment options in terms of MSA. There were no significant differences in clinical outcomes between calcium‐modification strategies. Conclusions Compared with standard noncompliant balloons, RA and balloon‐based strategies improved the mechanical performance of PCI in calcified coronary lesions. However, this did not result in better clinical outcomes.
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Simonetti et al. (2026) conducted a meta-analysis in Calcified coronary lesions (n=4,855). Calcium-modification strategies (e.g., IVL, RA, SHPB, cutting/scoring balloons) vs. Noncompliant balloons was evaluated on Minimal stent area (MSA) (MD 0.87, 95% CI 0.40-1.34, p=<0.001). Compared with standard noncompliant balloons, intravascular lithotripsy, rotational atherectomy, and other balloon-based strategies significantly improved minimal stent area in calcified coronary lesions, though without significant differences in clinical outcomes.
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