{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:56:18Z","timestamp":1790571378341,"version":"4.1.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe coronary artery calcification (CAC) is associated with adverse events after percutaneous coronary intervention (PCI), traditionally attributed to inadequate stent expansion. Whether severe CAC confers residual risk despite optimal acute mechanical results remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective study included 709 patients who underwent pre-procedural intravascular ultrasound (IVUS) before PCI. Patients were classified as no calcification (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009417), mild CAC (arc \u2264180\u00b0 or length \u22645\u2005mm,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009168), or severe CAC (arc &amp;gt;180\u00b0 and length &amp;gt;5\u2005mm,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009124). The primary endpoint was clinically driven target vessel revascularization (TVR); the secondary endpoint was major adverse cardiovascular events (MACE). Post-PCI minimum stent area (MSA) and expansion index were compared across groups. Multivariable Cox regression using three prespecified adjustment models was performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a median follow-up of 18.6 months, 57 patients (8.0%) experienced TVR and 122 (17.2%) experienced MACE. Post-PCI MSA (5.9 vs. 5.6 vs. 5.8 mm\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.286) and expansion index (0.89 vs. 0.88 vs. 0.88;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.485) were comparable across groups, indicating acceptable acute stent expansion in severely calcified lesions. Nevertheless, severe CAC remained independently associated with increased TVR risk in the primary analysis (adjusted hazard ratio [aHR] 2.51, 95% CI 1.33\u20134.74,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005), persisting after extended adjustment (aHR 2.61,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007) and after excluding rotational atherectomy (RA) cases (aHR 2.29,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018). The association between severe CAC and MACE was more modest (aHR 1.77,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.014) and attenuated after extended adjustment (aHR 1.49,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.119). Calcified nodules, present in 64.5% of severe CAC lesions, independently predicted TVR (aHR 3.04,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Mild CAC showed no significant risk elevation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Severe CAC identifies a subgroup at persistently elevated risk for repeat revascularization despite achieving stent expansion comparable to non-calcified lesions, challenging the conventional paradigm linking calcification to adverse events solely through underexpansion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1897344","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:29:13Z","timestamp":1790569753000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Residual risk persists in severely calcified lesions despite optimal stent expansion: a paradoxical finding from an IVUS-guided PCI cohort"],"prefix":"10.3389","volume":"13","author":[{"given":"Shaowu","family":"Xiao","sequence":"first","affiliation":[{"name":"Second Clinical College, Hainan Medical University","place":["Haikou, China"]},{"name":"Department of Cardiovascular Internal Medicine, The Second Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengya","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Internal Medicine, The Second Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Liang","sequence":"additional","affiliation":[{"name":"Second Clinical College, Hainan Medical University","place":["Haikou, China"]},{"name":"Department of Cardiovascular Internal Medicine, The Second Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Mo","sequence":"additional","affiliation":[{"name":"Second Clinical College, Hainan Medical University","place":["Haikou, China"]},{"name":"Department of Cardiovascular Internal Medicine, The Second Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingchun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Internal Medicine, The Second Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/j.jacc.2024.12.009","article-title":"Management of coronary stent underexpansion","volume":"85","author":"Ng","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1161\/CIRCULATIONAHA.123.065657","article-title":"Coronary artery calcification: current concepts and clinical implications","volume":"149","author":"Onnis","year":"2024","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1959","DOI":"10.1161\/01.cir.91.7.1959","article-title":"Patterns of calcification in coronary artery disease. 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