Dual-Parameter IVUS Assessment of Coronary Calcification Stratifies the Risk of Adverse Events after PCI: A Retrospective Cohort Study

Background The prognostic value of a dual-parameter intravascular ultrasound (IVUS) assessment that integrates both the calcium arc and length to grade coronary artery calcification (CAC) severity is not well established in patients undergoing percutaneous coronary intervention (PCI). Methods This single-center, retrospective study included 709 patients who underwent coronary angiography and preprocedural IVUS. Patients were stratified according to the maximum calcium arc and length as follows: no calcification (n = 417), mild calcification (arc ≤ 180° or length ≤ 5 mm, n = 168), and severe calcification (arc > 180° and length > 5 mm, n = 124). The primary endpoint was the composite of major adverse cardiovascular events (MACEs). Results Over a median follow-up of 18.6 months, 122 patients (17.2%) experienced MACEs. Each increase in CAC severity grade was independently associated with a greater risk of MACEs (adjusted hazard ratio [aHR] 1.30, 95% CI 1.04–1.63; P for trend = 0.021). Compared with patients with no calcification, those with severe calcification had a significantly greater risk of MACEs (aHR 1.67, 95% CI 1.06–2.65; p = 0.028) and target vessel revascularization (TVR) (aHR 2.45, 95% CI 1.28–4.68; p = 0.007). No significant increase in risk was observed for the mild calcification group. Conclusion Severe coronary calcification, defined by IVUS as an arc > 180° with a length > 5 mm, is a strong and independent predictor of adverse outcomes after PCI. This dual-parameter IVUS assessment provides a refined tool for preprocedural risk stratification.