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Moderate-to-severe coronary calcification outcomes after PCI: A systematic review and meta-analysis of clinical presentation, imaging guidance, and contemporary stent era

Heart Science Journal · Vol. 7 No. 4 (2026) · hlm. 4–10

DOI
10.21776/ub.hsj.2026.007.04.2
ISSN
2721-9984, 2721-9976
Terbit
2026-10-13
Penerbit
Universitas Brawijaya
Bahasa
en
Lisensi
creativecommons.org/licenses/by/4.0

Abstrak

Background: Moderate to severe coronary calcification is generally considered to predict lesion complexity following percutaneous coronary intervention. It remains unknown whether the adverse prognostic impact persists in the current PCI era, especially with the development of stent technology, intracoronary imaging and lesion preparation techniques.Methods: A systematic review and meta-analysis were performed to assess the impact of moderate-to-severe coronary calcification on outcomes after PCI. Studies contrasting moderate-to-severe calcification with mild or no calcification were selected. The principal outcomes included cardiac mortality, MACE, recurrent myocardial infarction, and target lesion revascularization. Pooled relative risks with 95% confidence intervals were calculated using a random-effects Mantel–Haenszel model, with heterogeneity evaluated by the I² statistic. Subgroup analyses were chosen based on clinical presentation, imaging guidance, and stent production.Result: Six studies including over 19,000 patients were included. Moderate-to-severe coronary calcification was linked to a markedly elevated risk of cardiac mortality (RR 2.22, 95% CI 1.87–2.63; I² = 0%), major adverse cardiovascular events (MACE) (RR 1.74, 95% CI 1.40–2.16; I² = 83%), recurrent myocardial infarction (RR 1.57, 95% CI 1.30–1.89; I² = 31%), and target lesion revascularization (RR 1.79, 95% CI 1.34–2.38; I² = 80%) following PCI. Subgroup analysis showed a stronger association between TLR and non-ACS patients and clinical studies using current-generation stents, although calcification was detrimental regardless of intracoronary imaging guidance.. Conclusion: Despite advancements in modern stents and developing PCI techniques, moderate-to-severe coronary calcification persists in providing a significant residual risk following revascularization.

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Rekan penulisOrganisasiArtikel bersama
Anna Fuji RahimahUniversity of Brawijaya18
Cholid Tri TjahjonoUniversity of Brawijaya18
Ardian RizalUniversity of Brawijaya18
Budi SatrijoUniversity of Brawijaya18
Indra PrasetyaUniversity of Brawijaya17
Setyasih AnjarwaniUniversity of Brawijaya16
Novi KurnianingsihUniversity of Brawijaya14
Yoga WaranugrahaUniversity of Brawijaya9
Djanggan SargowoUniversity of Brawijaya9
Sasmojo WiditoUniversity of Brawijaya9
Heny MartiniUniversity of Brawijaya9
Adhika Prastya WikanandaUniversity of Brawijaya4
Tri AstiawatiUniversity of Brawijaya4
Putri Annisa KamilaUniversity of Brawijaya3
Dadang HendrawanUniversity of Brawijaya3
Muhammad Rizki FadlanUniversity of Brawijaya3
Fandy HazzyUniversity of Brawijaya3
Wella KarolinaUniversity of Brawijaya3
Hayla Iqda MillisaniUniversity of Brawijaya3
Oktivani Adelathifa RahmaUniversity of Brawijaya3
Veny KurniawatiUniversity of Brawijaya2
Tonny AdriyantoUniversity of Brawijaya2
Jonny Karunia FajarUniversity of Brawijaya2
Olivia HandayaniUniversity of Brawijaya2
Fahmy RusnantaUniversity of Brawijaya2
Fitranti Suciati LaitupaUniversity of Brawijaya2
Oktafin Srywati PamunaUniversity of Brawijaya2
Anna Fuji RahimahAfiliasi tidak diketahui2
Imelda KrisnasariUniversity of Brawijaya2
Ratna PancasariUniversity of Brawijaya2
Ayu Asri Devi AdityawatiUniversity of Brawijaya2
Krishna Ari NugrahaUniversity of Brawijaya2
Seprian WidasmaraUniversity of Brawijaya2
Pawik SupriadiUniversity of Brawijaya2
Wira KimahesaUniversity of Brawijaya2
Valerinna YogibuanaAfiliasi tidak diketahui2
Cik KahadiUniversity of Brawijaya2

Afiliasi berasal dari OpenAlex; metadata OAI-PMH jurnal tidak memuatnya. Penulis tanpa ID OpenAlex dicocokkan berdasarkan nama, sehingga dua orang bisa tergabung atau satu orang bisa terpisah.

Sumber metadata: OAI-PMH (metadata jurnal) https://heartscience.ub.ac.id/index.php/heartscience/oai, pertama di-harvest 8 Nov 2026, terakhir terlihat 8 Nov 2026.
Metadata asli (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en">Moderate-to-severe coronary calcification outcomes after PCI: A systematic review and meta-analysis of clinical presentation, imaging guidance, and contemporary stent era</dc:title>
	<dc:creator xml:lang="en">Veliawan, Zhafran</dc:creator>
	<dc:creator xml:lang="en">Rohman, Mohammad Saifur</dc:creator>
	<dc:creator xml:lang="en">Firdaus, Dylan Hanny</dc:creator>
	<dc:subject xml:lang="en">Coronary artery calcification</dc:subject>
	<dc:subject xml:lang="en"> major adverse cardiovascular events</dc:subject>
	<dc:subject xml:lang="en">target lesion revascularization</dc:subject>
	<dc:subject xml:lang="en">clinical outcome</dc:subject>
	<dc:description xml:lang="en">Background: Moderate to severe coronary calcification is generally considered to predict lesion complexity following percutaneous coronary intervention. It remains unknown whether the adverse prognostic impact persists in the current PCI era, especially with the development of stent technology, intracoronary imaging and lesion preparation techniques.Methods:  A systematic review and meta-analysis were performed to assess the impact of moderate-to-severe coronary calcification on outcomes after PCI. Studies contrasting moderate-to-severe calcification with mild or no calcification were selected. The principal outcomes included cardiac mortality, MACE, recurrent myocardial infarction, and target lesion revascularization. Pooled relative risks with 95% confidence intervals were calculated using a random-effects Mantel–Haenszel model, with heterogeneity evaluated by the I² statistic. Subgroup analyses were chosen based on clinical presentation, imaging guidance, and stent production.Result: Six studies including over 19,000 patients were included. Moderate-to-severe coronary calcification was linked to a markedly elevated risk of cardiac mortality (RR 2.22, 95% CI 1.87–2.63; I² = 0%), major adverse cardiovascular events (MACE) (RR 1.74, 95% CI 1.40–2.16; I² = 83%), recurrent myocardial infarction (RR 1.57, 95% CI 1.30–1.89; I² = 31%), and target lesion revascularization (RR 1.79, 95% CI 1.34–2.38; I² = 80%) following PCI. Subgroup analysis showed a stronger association between TLR and non-ACS patients and clinical studies using current-generation stents, although calcification was detrimental regardless of intracoronary imaging guidance.. Conclusion: Despite advancements in modern stents and developing PCI techniques, moderate-to-severe coronary calcification persists in providing a significant residual risk following revascularization.</dc:description>
	<dc:publisher xml:lang="en">Universitas Brawijaya</dc:publisher>
	<dc:date>2026-10-13</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>https://heartscience.ub.ac.id/index.php/heartscience/article/view/20771</dc:identifier>
	<dc:identifier>10.21776/ub.hsj.2026.007.04.2</dc:identifier>
	<dc:source xml:lang="en">Heart Science Journal; Vol. 7 No. 4 (2026): Navigating High-Risk Cardiovascular Subsets: Premature Disease, Plaque Complexity, and Precision Interventions; 4-10</dc:source>
	<dc:source>2721-9984</dc:source>
	<dc:source>2721-9976</dc:source>
	<dc:source>10.21776/ub.hsj.2026.007.04</dc:source>
	<dc:language>en</dc:language>
	<dc:relation>https://heartscience.ub.ac.id/index.php/heartscience/article/view/20771/613</dc:relation>
	<dc:rights xml:lang="en">Copyright (c) 2026 Zhafran Veliawan, Mohammad Saifur Rohman, Dylan Hanny Firdaus</dc:rights>
	<dc:rights xml:lang="en">http://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>