Impact of Plaque Morphology on Drug-Coated Balloon Treatment Outcomes for Coronary Calcified Lesions: An Optical Coherence Tomography Analysis.

Background: Percutaneous coronary intervention (PCI) for calcified coronary lesions without stent implantation remains a challenging therapeutic strategy. The efficacy of drug-coated balloon (DCB) therapy in relation to specific calcified plaque morphologies has not been previously investigated. Methods and Results: We conducted a retrospective analysis of 150 lesions (136 patients) who underwent optical coherence tomography (OCT)-guided PCI using DCB for angiographically moderate-to-severe calcified lesions. Based on the OCT findings, target lesions were categorized into 3 groups: superficial calcific sheet (SC) group; calcific protrusion (CP) group; and eruptive calcified nodule (eCN) group. Long-term clinical outcomes, including clinically driven target lesion revascularization (CD-TLR), myocardial infarction (MI), cardiac death, and the composite endpoint of major adverse cardiovascular events (MACE), were assessed over a median follow up of 2.6 years. No significant differences in rates of CD-TLR, MI, cardiac death, or MACE were observed between the SC and CP groups. In contrast, the eCN group showed significantly higher incidences of MI (P<0.01 vs. SC; P<0.05 vs. CP), cardiac death (P<0.01 vs. SC and CP), and MACE (P<0.01 vs. SC and CP) compared with the other 2 groups. Conclusions: In moderate-to-severe calcified lesions where adequate vessel preparation was achieved, DCB therapy was associated with favorable outcomes in lesions with SC or CP morphologies. In contrast, lesions involving eCN were linked to significantly worse clinical outcomes.