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
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.