Angiographic calcification severity and clinical predictors of 3-month outcomes after PCI for calcified coronary lesions

Background: Coronary artery calcification (CAC) is associated with increased procedural complexity and adverse outcomes after percutaneous coronary intervention (PCI). However, its prognostic relevance in the era of contemporary plaque modification and intravascular imaging remains uncertain.. Objective: To evaluate the association between angiographic calcification severity and 3-month major adverse cardiovascular events (MACE), and to identify independent predictors of outcomes in patients undergoing PCI for calcified coronary lesions. Methods: This retrospective cohort study included 413 patients with angiographically confirmed coronary calcification who underwent coronary angiography followed by percutaneous coronary intervention (PCI) at a tertiary referral center in Indonesia. Patients were categorized into non-severe (n=269) and severe (n=144) calcification groups. Baseline characteristics, angiographic profiles, and procedural parameters were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of 3-month major adverse cardiovascular events (MACE). Result: Baseline characteristics were generally comparable between groups, although smoking history and body mass index differed significantly. Severe calcification was associated with greater procedural complexity, including increased use of rotational atherectomy and lesion preparation strategies; however, intravascular imaging use and final procedural success were similar. At 3 months, there were no significant differences in MACE between groups, including mortality, myocardial infarction, stroke, target lesion revascularization, and heart failure rehospitalization (all p > 0.05). On multivariable analysis, calcification severity was not an independent predictor of MACE. Instead, age, prior PCI, dyslipidemia, hypertension, alcohol use, family history, and prior CABG were outcome-specific predictors. Conclusion: Angiographic coronary calcification severity was not significantly associated with 3-month MACE in this contemporary PCI cohort, suggesting attenuation of its short-term prognostic impact in the modern interventional era.