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Publications

Journal Article Network Meta-Analysis Systematic Review Ppublish 1 citation

PubMed: 42670048 DOI: 10.1155/cdr/9434123

Comparative Performance of Calcium-Modification Strategies for Coronary Lesions: A Network Meta-Analysis of Randomized Trials.

Cardiovasc Ther 2026(1):e9434123

Authors: Fiorenzo Simonetti, Andreas T Kristensen, Tobias Lenz, Felix Voll, Moritz von Scheidt, Michael Joner, Tobias Rheude, Hendrik Sager, Erion Xhepa, Adnan Kastrati, Niels Thue Olsen, Salvatore Cassese

Affiliations

  • Department of Cardiovascular Diseases, TUM Klinikum Deutsches Herzzentrum, Technical University of Munich, Munich, Germany, tum.de.
  • Deutsches Zentrum für Herz-und Kreislauf-Forschung (DZHK) e.V. (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
  • Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy, unina.it.
  • Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, rigshospitalet.dk.

Abstract

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.

MeSH

Stents, Percutaneous Coronary Intervention, Network Meta-Analysis, Calcium, Atherectomy, Wounds And Injuries, Endovascular Procedures