Impact of Coronary Artery Calcification on PCI Outcomes in Pakistani Patients

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality globally, particularly in low- and middle-income countries such as Pakistan. Percutaneous coronary intervention (PCI) is a crucial treatment for CAD, but the presence of coronary artery calcification (CAC) complicates procedures and affects outcomes. CAC is associated with increased procedural complexity, higher rates of restenosis, and adverse cardiovascular events. Objective: This study aimed to investigate the impact of CAC on PCI outcomes in Pakistani patients, focusing on major adverse cardiovascular events (MACE), restenosis rates, and stent thrombosis. Methods: This observational cohort study was conducted at Hayatabad Medical Complex, Peshawar, from January 2022 to December 2023. The study included 500 patients aged 35-80 years who underwent PCI. Patients were categorized based on their CAC scores obtained through coronary computed tomography angiography (CCTA): low (<100), moderate (100-400), and high (>400). Data on baseline characteristics, CAC scores, and outcomes were collected from patient records and interviews. The primary outcome was the incidence of MACE within 12 months post-PCI. Secondary outcomes included restenosis and stent thrombosis rates. Statistical analysis was performed using SPSS version 25.0, employing ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p<0.05. Results: The mean age of the participants was 58.2 years (SD = 10.4), with 60% men and 40% women. Higher CAC scores were significantly associated with increased MACE incidence: 15% in the low group, 25% in the moderate group, and 45% in the high group. Restenosis rates were 10%, 20%, and 35%, and stent thrombosis rates were 5%, 10%, and 20% for the low, moderate, and high CAC score groups, respectively. Statistical analysis confirmed significant differences across CAC score groups for primary and secondary outcomes (p<0.05). Conclusion: The study demonstrated that higher CAC scores significantly impact PCI outcomes in Pakistani patients, leading to increased MACE, restenosis, and stent thrombosis rates. These findings highlight the importance of incorporating CAC assessment in clinical practice to improve risk stratification and personalize treatment strategies for better patient outcomes.