Jennifer Huisman1, Liefke C van der Heijden1, Marlies M Kok1, Peter W Danse2, Gillian A J Jessurun3, Martin G Stoel1, K Gert van Houwelingen1, Marije M Löwik1, Raymond W M Hautvast4, Maarten J IJzerman5, Carine J Doggen5, Clemens von Birgelen6. 1. Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands. 2. Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands. 3. Department of Cardiology, Treant Zorggroep, Emmen, Netherlands. 4. Department of Cardiology, Medical Center Alkmaar, Alkmaar, Netherlands. 5. Health Technology and Services Research, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands. 6. Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands; Health Technology and Services Research, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands. Electronic address: c.vonbirgelen@mst.nl.
Abstract
BACKGROUND: The outcome of percutaneous coronary intervention with newer generation permanent polymer-coated drug-eluting stents (DES) in patients with severely calcified lesions is greatly unknown. We assessed the impact of severe lesion calcification on clinical outcome in patients with stable angina who underwent percutaneous coronary intervention with newer generation DES. METHODS: TWENTE and DUTCH PEERS randomized trials enrolled 1423 patients with stable angina, who were categorized into patients with versus without severe target lesion calcification. A patient-level pooled analysis assessed clinical outcome, including target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization (TVR). RESULTS:Patients with severe calcification (n = 342) were older (66.6 ± 9.1 vs 64.2 ± 9.8 years, P < .001) and had more diabetes (25.7% vs 20.4%, P = .04) than other patients (n = 1081). Patients with calcified lesions had higher rates of TVF (16.4% vs 9.8%, pLogrank = .001), cardiac death (4.4% vs 1.5%, P = .03), target vessel myocardial infarction (7.6% vs 3.4%, P = .001), and definite stent thrombosis (1.8% vs 0.4%, P = .02). Multivariate analysis demonstrated that severe calcification was an independent risk factor of 2-year TVF (HR 1.42, 95% CI: 1.02-1.99, pLogrank = .04); landmark analysis showed that this was based on a difference during the first year (periprocedural: 5.8% vs. 3.1%, pLogrank = .02; first year: 7.5% vs. 3.8%, pLogrank = .007; second year: 4.1% vs. 3.3%, pLogrank = .54). CONCLUSION: In patients with stable angina, severe target lesion calcification is associated with an increased risk of adverse cardiovascular events following treatment with newer generation permanent polymer-coated DES. This increase in risk is restricted to the first year of follow-up, which is an encouraging finding.
RCT Entities:
BACKGROUND: The outcome of percutaneous coronary intervention with newer generation permanent polymer-coated drug-eluting stents (DES) in patients with severely calcified lesions is greatly unknown. We assessed the impact of severe lesion calcification on clinical outcome in patients with stable angina who underwent percutaneous coronary intervention with newer generation DES. METHODS: TWENTE and DUTCH PEERS randomized trials enrolled 1423 patients with stable angina, who were categorized into patients with versus without severe target lesion calcification. A patient-level pooled analysis assessed clinical outcome, including target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization (TVR). RESULTS:Patients with severe calcification (n = 342) were older (66.6 ± 9.1 vs 64.2 ± 9.8 years, P < .001) and had more diabetes (25.7% vs 20.4%, P = .04) than other patients (n = 1081). Patients with calcified lesions had higher rates of TVF (16.4% vs 9.8%, pLogrank = .001), cardiac death (4.4% vs 1.5%, P = .03), target vessel myocardial infarction (7.6% vs 3.4%, P = .001), and definite stent thrombosis (1.8% vs 0.4%, P = .02). Multivariate analysis demonstrated that severe calcification was an independent risk factor of 2-year TVF (HR 1.42, 95% CI: 1.02-1.99, pLogrank = .04); landmark analysis showed that this was based on a difference during the first year (periprocedural: 5.8% vs. 3.1%, pLogrank = .02; first year: 7.5% vs. 3.8%, pLogrank = .007; second year: 4.1% vs. 3.3%, pLogrank = .54). CONCLUSION: In patients with stable angina, severe target lesion calcification is associated with an increased risk of adverse cardiovascular events following treatment with newer generation permanent polymer-coated DES. This increase in risk is restricted to the first year of follow-up, which is an encouraging finding.
Authors: Keyvan Karimi Galougahi; Evan Shlofmitz; Allen Jeremias; Shawnbir Gogia; Ajay J Kirtane; Jonathan M Hill; Dimitri Karmpaliotis; Gary S Mintz; Akiko Maehara; Gregg W Stone; Richard A Shlofmitz; Ziad A Ali Journal: Curr Cardiol Rep Date: 2021-03-05 Impact factor: 2.931
Authors: Rosaly A Buiten; Eline H Ploumen; Paolo Zocca; Carine J M Doggen; K Gert van Houwelingen; Peter W Danse; Carl E Schotborgh; Martin G Stoel; Martijn Scholte; Gerard C M Linssen; Frits H A F de Man; Clemens von Birgelen Journal: Catheter Cardiovasc Interv Date: 2020-04-01 Impact factor: 2.692