Impact of Native Coronary Artery Calcification on Lesion Outcome Following Drug-Coated Balloon Angioplasty for Treatment of In-Stent Restenosis

This study aimed to clarify whether native coronary artery(CA) calci cation before index percutaneous coronary intervention(PCI) has an impact on the effectiveness of drug-coated balloon(DCB) angioplasty for the treatment of instent restenosis(ISR). 100 consecutive patients with 166 ISR lesions underwent quantitative coronary angiography(QCA) before and after index PCI and before and after DCB angioplasty for ISR. CA calci cation before index PCI was assessed by angiography and results were analyzed to reveal the predictive values for target lesion revascularization(TLR) and major adverse cardiac events(MACE). During 1.03±1.03 years of follow-up, TLR occurred in 44 lesions(26.5%) and MACE in 33 patients(33%). On multivariate analysis, CA calci cation before index PCI (p=0.016), and % diameter of stenosis(%DS)≥73%(p=0.023) and minimal lumen diameter(MLD)<0.65 mm(p=0.001) before DCB angioplasty were independent predictors for TLR after DCB angioplasty. MACE was also associated with CA calci cation before index PCI(p=0.01), and %DS ≥ 73%(p=0.001) and MLD<0.65 mm(p=0.01) before DCB angioplasty, but only %DS≥73% before DCB angioplasty was an independent predictor for MACE after DCB angioplasty (p=0.039). The combination of CA calci cation before index PCI and these QCA factors before DCB angioplasty was an independent and more powerful predictor for MACE than the QCA factors alone(p<0.001). Thereafter, the combination of CA calci cation and %DS ≥ 73% before DCB angioplasty strati ed the risk of MACE after DCB angioplasty(p<0.05). CA calcification before index PCI, as well as anatomical information at ISR, have an impact on outcome after DCB angioplasty for ISR.