Comparative Performance of Calcium-Modification Strategies for Coronary Lesions: A Network Meta-Analysis of Randomized Trials.
F, S., AT, K., T, L., F, V., M, v.S., M, J., T, R., H, S., E, X., & A, K. (2026). Comparative Performance of Calcium-Modification Strategies for Coronary Lesions: A Network Meta-Analysis of Randomized Trials.. Cardiovascular therapeutics. https://doi.org/10.1155/cdr/9434123
F S, AT K, T L, F V, M vS, M J, et al. Comparative Performance of Calcium-Modification Strategies for Coronary Lesions: A Network Meta-Analysis of Randomized Trials.. Cardiovascular therapeutics. 2026; doi: 10.1155/cdr/9434123
F S, AT K, T L, et al. Comparative Performance of Calcium-Modification Strategies for Coronary Lesions: A Network Meta-Analysis of Randomized Trials.[J]. Cardiovascular therapeutics. 2026. DOI: 10.1155/cdr/9434123.
@article{f2026,
author = {Simonetti F and Kristensen AT and Lenz T and Voll F and von Scheidt M and Joner M and Rheude T and Sager H and Xhepa E and Kastrati A},
title = {Comparative Performance of Calcium-Modification Strategies for Coronary Lesions: A Network Meta-Analysis of Randomized Trials.},
journal = {Cardiovascular therapeutics},
year = {2026},
doi = {10.1155/cdr/9434123},
note = {PMID: 42670048},
}
TY - JOUR AU - Simonetti F AU - Kristensen AT AU - Lenz T AU - Voll F AU - von Scheidt M AU - Joner M AU - Rheude T AU - Sager H AU - Xhepa E AU - Kastrati A TI - Comparative Performance of Calcium-Modification Strategies for Coronary Lesions: A Network Meta-Analysis of Randomized Trials. T2 - Cardiovascular therapeutics PY - 2026 DO - 10.1155/cdr/9434123 AN - PMID:42670048 ER -
INTRODUCTION AND OBJECTIVES: Calcified coronary lesions are associated with an increased risk of percutaneous coronary intervention (PCI) failure. Despite the availability of several calcium-modification strategies and randomized trials evaluating their efficacy, comparative investigations remain scanty. The aim of the present analysis is to assess the comparative performance of calcium-modification strategies in patients undergoing PCI of calcified coronary lesions. METHODS: We conducted a systematic search for randomized trials evaluating calcium-modification strategies in patients undergoing PCI. Random-effects network meta-analyses were performed. The primary outcome was minimal stent area (MSA). Secondary outcomes included all-cause death and stent thrombosis. RESULTS: Twenty-two trials enrolling 4855 patients were included. Compared to calcium modification with noncompliant balloons, the use of cutting/scoring balloon (mean difference: 0.81 mm2, 95% confidence interval: [0.36, 1.27]; p = 0.001), super high-pressure balloon (SHPB, 0.95 mm2 [0.18, 1.72]; p = 0.016), intravascular lithotripsy (IVL, 0.87 mm2 [0.40, 1.34]; p < 0.001), rotational atherectomy (RA, 0.90 mm2 [0.30, 1.50]; p = 0.003), and RA plus cutting balloon (1.24 mm2 [0.46, 2.02]; p = 0.002) led to larger MSA. According to a network ranking analysis, RA, SHPB, and IVL were possibly the best treatment options in terms of MSA. There were no significant differences in clinical outcomes between calcium-modification strategies. CONCLUSIONS: Compared with standard noncompliant balloons, RA and balloon-based strategies improved the mechanical performance of PCI in calcified coronary lesions. However, this did not result in better clinical outcomes.