The risk factors and long-term clinical outcomes of percutaneous coronary intervention (PCI) procedure failure for patients with angiography-proven moderate-to-severe coronary calcification (MSCC) have not yet been adequately assessed.

A total of 4014 patients with angiography-proven MSCC were consecutively recruited from January 2017 to December 2018 at Fuwai Hospital. All participants were also separated into 2 groups based on PCI procedure failure or success.Procedure failure was defined as the residual stenosis ≥ 50%, occurrence of severe angiographic complications, or occurrence of an in-hospital death or in-hospital myocardial infarction (MI). The primary endpoint was cardiovascular (CV) events including CV death, nonfatal MI and nonfatal stroke.

The incidence of procedure failure for MSCC lesion was 10.86% (436/4014). During a median 3-year follow-up, 130 CV events occurred. Overall, patients with procedure failure showed increased risk of CV events (hazard ratio: 2.07; 95% confidence interval: 1.32-3.24) than those with procedure succuss after multivariable adjustment. Application of intravascular ultrasound and rotational atherectomy were independent protective factors for occurrence of PCI procedure failure in patients with severe calcification (all p < 0.05). For those had suffered with PCI procedure failure, elderly age, prior revascularization, higher fasting blood glucose, and more thrombotic lesion were independent risk factors for adverse CV events (all p < 0.05).

MSCC patients with PCI procedure failure showed unfavorable long-term clinical outcomes. Intravascular ultrasound and rotational atherectomy might reduce the risk of PCI procedure failure occurrence for patients with severe calcification. More strict glucose control might reduce the risk of adverse CV events for MSCC patient who suffered with PCI procedure failure.