Gennaro Giustino1, Ioannis Mastoris1, Usman Baber1, Samantha Sartori1, Gregg W Stone2, Martin B Leon2, Patrick W Serruys3, Adnan Kastrati4, Stephan Windecker5, Marco Valgimigli5, George D Dangas1, Clemens Von Birgelen6, Pieter C Smits7, David Kandzari8, Soren Galatius9, William Wijns10, P Gabriel Steg11, Giulio G Stefanini12, Melissa Aquino1, Marie-Claude Morice13, Edoardo Camenzind14, Giora Weisz15, Raban V Jeger16, Takeshi Kimura17, Ghada W Mikhail18, Dipti Itchhaporia19, Laxmi Mehta20, Rebecca Ortega21, Hyo-Soo Kim22, Alaide Chieffo23, Roxana Mehran24. 1. Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Department of Cardiology, Columbia University Medical Center, New York, New York. 3. Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands. 4. Department of Cardiology, Herzzentrum, Munich, Germany. 5. Department of Cardiology, Bern University Hospital, Bern, Switzerland. 6. Department of Cardiology, Thoraxcentrum Twente, Enschede, the Netherlands. 7. Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands. 8. Piedmont Heart Institute, Atlanta, Georgia. 9. Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. 10. Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium. 11. Département Hospitalo Universitaire Fibrose, Inflammation et Remodelage, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U114, Paris, France. 12. Division of Clinical and Interventional Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy. 13. Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Paris, France. 14. Department of Cardiology, Institut Lorrain du Coeur et des Vaisseaux University Hospital Nancy - Brabois, Vandoeuvre-lès-Nancy, France. 15. Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel; Columbia University Medical Center, New York, New York. 16. Department of Cardiology, University Hospital Basel, Basel, Switzerland. 17. Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan. 18. Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom. 19. Department of Cardiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California. 20. Department of Cardiology, The Ohio State University Medical Center, Columbus, Ohio. 21. Duke Clinical Research Institute, Durham, North Carolina. 22. Department of Cardiology, Seoul National University Main Hospital, Seoul, Korea. 23. Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy. 24. Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: roxana.mehran@mountsinai.org.
Abstract
OBJECTIVES: The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES). BACKGROUND: The clinical correlates and the prognostic significance of CAC in women undergoing percutaneous coronary intervention with DES remain unclear. METHODS: Patient-level data from female participants in 26 randomized trials of DES were pooled. Study population was categorized according to the presence of moderate or severe versus mild or no target lesion CAC, assessed through coronary angiography. Co-primary endpoints of interest were the composite of death, myocardial infarction (MI), or target lesion revascularization and death, MI, or stent thrombosis at 3-year follow-up. RESULTS: Among 11,557 women included in the pooled dataset, CAC status was available in 6,371 women. Of these, 1,622 (25.5%) had moderate or severe CAC. In fully adjusted models, independent correlates of CAC were age, hypertension, hypercholesterolemia, smoking, previous coronary artery bypass graft surgery, and worse left ventricular and renal function. At 3 years, women with CAC were at higher risk for death, MI, or target lesion revascularization (18.2% vs. 13.1%; adjusted hazard ratio: 1.56; 95% confidence interval: 1.33 to 1.84; p < 0.0001) and death, MI, or stent thrombosis (12.7% vs. 8.6%; adjusted hazard ratio: 1.48; 95% confidence interval: 1.21 to 1.80; p = 0.0001). The adverse effect of CAC on ischemic outcomes appeared to be consistent across clinical and angiographic subsets of women, including new-generation DES. CONCLUSIONS: Women undergoing PCI of calcified lesions tend to have worse clinical profile and remain at increased ischemic risk, irrespective of new-generation DES.
OBJECTIVES: The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES). BACKGROUND: The clinical correlates and the prognostic significance of CAC in women undergoing percutaneous coronary intervention with DES remain unclear. METHODS:Patient-level data from female participants in 26 randomized trials of DES were pooled. Study population was categorized according to the presence of moderate or severe versus mild or no target lesion CAC, assessed through coronary angiography. Co-primary endpoints of interest were the composite of death, myocardial infarction (MI), or target lesion revascularization and death, MI, or stent thrombosis at 3-year follow-up. RESULTS: Among 11,557 women included in the pooled dataset, CAC status was available in 6,371 women. Of these, 1,622 (25.5%) had moderate or severe CAC. In fully adjusted models, independent correlates of CAC were age, hypertension, hypercholesterolemia, smoking, previous coronary artery bypass graft surgery, and worse left ventricular and renal function. At 3 years, women with CAC were at higher risk for death, MI, or target lesion revascularization (18.2% vs. 13.1%; adjusted hazard ratio: 1.56; 95% confidence interval: 1.33 to 1.84; p < 0.0001) and death, MI, or stent thrombosis (12.7% vs. 8.6%; adjusted hazard ratio: 1.48; 95% confidence interval: 1.21 to 1.80; p = 0.0001). The adverse effect of CAC on ischemic outcomes appeared to be consistent across clinical and angiographic subsets of women, including new-generation DES. CONCLUSIONS:Women undergoing PCI of calcified lesions tend to have worse clinical profile and remain at increased ischemic risk, irrespective of new-generation DES.
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: Gennaro Giustino; Rafael Harari; Usman Baber; Samantha Sartori; Gregg W Stone; Martin B Leon; Stephan Windecker; Patrick W Serruys; Adnan Kastrati; Clemens Von Birgelen; Takeshi Kimura; Giulio G Stefanini; George D Dangas; William Wijns; P Gabriel Steg; Marie-Claude Morice; Edoardo Camenzind; Giora Weisz; Pieter C Smits; Sabato Sorrentino; Madhav Sharma; Serdar Farhan; Michela Faggioni; David Kandzari; Soren Galatius; Raban V Jeger; Marco Valgimigli; Dipti Itchhaporia; Laxmi Mehta; Hyo-Soo Kim; Alaide Chieffo; Roxana Mehran Journal: JAMA Cardiol Date: 2017-08-01 Impact factor: 14.676
Authors: Thomas J Ford; Adnan Khan; Kieran F Docherty; Alice Jackson; Andrew Morrow; Novalia Sidik; Paul Rocchiccioli; Richard Good; Hany Eteiba; Stuart Watkins; Aadil Shaukat; Mitchell Lindsay; Keith Robertson; Mark Petrie; Colin Berry; Keith G Oldroyd; Margaret McEntegart Journal: Catheter Cardiovasc Interv Date: 2019-07-01 Impact factor: 2.692
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