Network meta-analysis of treatment strategies for calcified coronary lesions

作者：Michele Maremmani, Gabriele Luigi Gasparini, Francesco Bruno, Sergio Berti, Simonluca Digiacomo, Ramin Ebrahimi, C Templin, Paolo Canova, Gabriele Pesarini, Davide Di Vece · 发表于：Zurich Open Repository and Archive (University of Zurich) · 年份：2026 · DOI：10.5167/uzh-290719 · 研究领域：Coronary Interventions and Diagnostics、Cardiac Imaging and Diagnostics、Atrial Fibrillation Management and Outcomes

Comparative evidence on treatment strategies for calcified coronary lesions (CCL) remains scarce, with few head-to-head trials and limited data on clinical outcomes. We conducted a frequentist network meta-analysis of randomized controlled trials (RCTs) comparing excimer laser (ELCA), lithotripsy (IVL), modified balloons (MBA), orbital atherectomy (OA), rotational atherectomy (RA), and RA plus cutting balloons (RA plus CBA) against a conventional strategy (CS). The primary endpoints were severe adverse events (SAE: death, coronary perforation, or slow-flow/no-reflow) and minimum stent area (MSA), while secondary endpoints included major adverse cardiovascular events (MACE) and target lesion revascularization (TLR). Fourteen RCTs including 3,671 patients were analyzed. Atherectomy-based strategies carried a higher risk of SAE versus CS, driven by slow-flow/no-reflow phenomenon. All strategies except OA and ELCA significantly increased MSA compared with CS, with the largest effect observed for RA plus CBA (MD 0.93 mm²; 95% CI 0.48-1.38). None of the strategies reduced MACE or TLR versus CS, although RA plus CBA ranked highest for both endpoints. IVL improved MSA (MD 0.59 mm²; 95% CI 0.14-1.03) without increasing SAE and ranked favorably for MACE and TLR, with the highest probability of lower mortality. Stand-alone MBA remained low-ranked for TLR, and sensitivity analysis confirmed its inferior MSA performance versus IVL. In summary, upfront plaque-modification improved MSA comp...