Abstract
BACKGROUND AND AIMS: Coronary artery calcification (CAC) is a predictor of poor prognosis after percutaneous coronary intervention (PCI), and its treatment depends on calcification severity assessed by intravascular imaging such as intravascular ultrasound (IVUS). We aimed to investigate the factors associated with CAC severity and clinical outcomes, with a particular focus on the potential impact of angiotensin-converting enzyme inhibitor (ACEI) use. METHODS: We retrospectively analyzed 630 patients with stable coronary artery disease who underwent IVUS-guided PCI between January 2018 and March 2023. Calcification severity was assessed using IVUS, and patients were grouped into moderate/severe and none/mild calcification. Outcomes included all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS: Patients with moderate/severe calcification had a significantly lower survival rate and a higher incidence of MACCEs (p = 0.02 and p < 0.001, respectively). Similarly, patients with calcified nodules had worse outcomes (p = 0.005 and p < 0.001, respectively). ACEI use was independently associated with reduced odds of moderate/severe calcification [OR: 0.56, 95% confidence intervals (CI): 0.36-0.90, p = 0.02] and calcified nodules (OR: 0.10, 95% CI: 0.01-0.74, p = 0.02). In patients with moderate/severe calcification, ACEI use was associated with a lower MACCE rate (p = 0.04). CONCLUSION: IVUS-assessed moderate/severe calcification is a strong predictor of all-cause death and MACCE in patients with CAD undergoing PCI. ACEI use was associated with less severe calcification and a lower incidence of MACCE in these patients. Evaluation of calcification may help identify high-risk patients and guide anti-calcification treatment strategies.