Philippe Généreux1, Mahesh V Madhavan2, Gary S Mintz3, Akiko Maehara3, Tullio Palmerini4, Laura Lasalle5, Ke Xu5, Tom McAndrew5, Ajay Kirtane3, Alexandra J Lansky6, Sorin J Brener7, Roxana Mehran8, Gregg W Stone9. 1. New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada. 2. New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York. 3. New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York. 4. Istituto di Cardiologia, University of Bologna, Bologna, Italy. 5. Cardiovascular Research Foundation, New York, New York. 6. Yale School of Medicine, New Haven, Connecticut. 7. Cardiovascular Research Foundation, New York, New York; New York Methodist Hospital, New York, New York. 8. Cardiovascular Research Foundation, New York, New York; Mount Sinai Medical Center, New York, New York. 9. New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.
Abstract
OBJECTIVES: This study sought to determine the frequency and impact of coronary calcification among patients undergoingpercutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). BACKGROUND: Small studies in patients with stable coronary artery disease have suggested a worse prognosis after PCI of calcified compared with noncalcified lesions. Little is known about the impact of coronary calcification on outcomes after PCI for patients presenting with non-ST-segment elevation and ST-segment elevation ACS. METHODS: Data from 6,855 patients presenting with ACS in whom PCI was performed were pooled from 2 large-scale randomized, controlled trials, ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) and HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction). One-year outcomes were analyzed according to the severity of PCI target lesion calcification (none/mild, moderate, or severe) as assessed by an independent angiographic core laboratory. RESULTS:Target lesion calcification was severe in 402 patients (5.9%), moderate in 1,788 (26.1%), and none/mild in 4,665 (68.1%). Moderate/severe target lesion calcification was more frequent in older patients, men, hypertensive patients, and those presenting with ST-segment elevation myocardial infarction (STEMI). The unadjusted 1-year rates of death, cardiac death, definite stent thrombosis, and ischemic target lesion revascularization (TLR) and target vessel revascularization were significantly increased in patients with moderate/severe target lesion calcification. By multivariable analysis, the presence of moderate/severe target lesion calcification was an independent predictor of 1-year definite stent thrombosis (hazard ratio [HR]: 1.62; 95% confidence interval [CI]: 1.14 to 2.30; p = 0.007) and ischemic TLR (HR: 1.44; 95% CI: 1.17 to 1.78; p = 0.0007). CONCLUSIONS:Moderate/severe lesion calcification was relatively frequent in patients with non-ST-segment elevation ACS and STEMI and was strongly predictive of stent thrombosis and ischemic TLR at 1 year. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158; Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966).
RCT Entities:
OBJECTIVES: This study sought to determine the frequency and impact of coronary calcification among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). BACKGROUND: Small studies in patients with stable coronary artery disease have suggested a worse prognosis after PCI of calcified compared with noncalcified lesions. Little is known about the impact of coronary calcification on outcomes after PCI for patients presenting with non-ST-segment elevation and ST-segment elevation ACS. METHODS: Data from 6,855 patients presenting with ACS in whom PCI was performed were pooled from 2 large-scale randomized, controlled trials, ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) and HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction). One-year outcomes were analyzed according to the severity of PCI target lesion calcification (none/mild, moderate, or severe) as assessed by an independent angiographic core laboratory. RESULTS: Target lesion calcification was severe in 402 patients (5.9%), moderate in 1,788 (26.1%), and none/mild in 4,665 (68.1%). Moderate/severe target lesion calcification was more frequent in older patients, men, hypertensivepatients, and those presenting with ST-segment elevation myocardial infarction (STEMI). The unadjusted 1-year rates of death, cardiac death, definite stent thrombosis, and ischemic target lesion revascularization (TLR) and target vessel revascularization were significantly increased in patients with moderate/severe target lesion calcification. By multivariable analysis, the presence of moderate/severe target lesion calcification was an independent predictor of 1-year definite stent thrombosis (hazard ratio [HR]: 1.62; 95% confidence interval [CI]: 1.14 to 2.30; p = 0.007) and ischemic TLR (HR: 1.44; 95% CI: 1.17 to 1.78; p = 0.0007). CONCLUSIONS: Moderate/severe lesion calcification was relatively frequent in patients with non-ST-segment elevation ACS and STEMI and was strongly predictive of stent thrombosis and ischemic TLR at 1 year. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158; Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966).
Authors: Rafał A Januszek; Artur Dziewierz; Zbigniew Siudak; Tomasz Rakowski; Jacek Legutko; Łukasz Rzeszutko; Paweł Kleczyński; Dariusz Dudek; Stanisław Bartuś Journal: Cardiol J Date: 2018-09-20 Impact factor: 2.737
Authors: Audrey L Blewer; Mary E Putt; Lance B Becker; Barbara J Riegel; Jiaqi Li; Marion Leary; Judy A Shea; James N Kirkpatrick; Robert A Berg; Vinay M Nadkarni; Peter W Groeneveld; Benjamin S Abella Journal: Circ Cardiovasc Qual Outcomes Date: 2016-10-04
Authors: Sung Sik Kim; Myong Hwa Yamamoto; Akiko Maehara; Novalia Sidik; Kohei Koyama; Colin Berry; Keith G Oldroyd; Gary S Mintz; Margaret McEntegart Journal: Int J Cardiovasc Imaging Date: 2018-04-16 Impact factor: 2.357