Philippe Généreux1, Björn Redfors2, Bernhard Witzenbichler3, Marie-Pier Arsenault4, Giora Weisz5, Thomas D Stuckey6, Michael J Rinaldi7, Franz-Josef Neumann8, D Christopher Metzger9, Timothy D Henry10, David A Cox11, Peter L Duffy12, Ernest L Mazzaferri13, Dominic P Francese2, Guillaume Marquis-Gravel4, Gary S Mintz2, Ajay J Kirtane14, Akiko Maehara14, Roxana Mehran15, Gregg W Stone14. 1. Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada; Morristown Medical Center, Morristown, NJ, USA. Electronic address: pgenereux@crf.org. 2. Cardiovascular Research Foundation, New York, NY, USA. 3. Helios Amper-Klinikum, Dachau, Germany. 4. Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada. 5. Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Shaare Zedek Medical Center, Jerusalem, Israel. 6. LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC, USA. 7. Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC, USA. 8. Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany. 9. Wellmont CVA Heart Institute, Kingsport, TN, USA. 10. Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA; Cedars-Sinai Heart Institute, Los Angeles, CA, USA. 11. Lehigh Valley Health Network, Allentown, PA, USA. 12. Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC, USA. 13. The Ohio State University Wexner Medical Center, Columbus, OH, USA. 14. Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA. 15. Cardiovascular Research Foundation, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is common and has been historically associated with an increased risk of adverse events. Whether the association between target lesion calcification (CAC) and outcomes differ across drug-eluting stent generation or between patients with high vs. low residual platelet reactivity (PR) remains unknown. We assessed the association of CAC with adverse ischemic and bleeding events among patients undergoing contemporary PCI with drug-eluting stents (DES). METHODS: We included all 8582 patients who underwent successful PCI with DES in the prospective ADAPT-DES study. Patients were grouped according to whether or not they had CAC. We used a multivariable logistic regression analysis to determine independent predictors of CAC. We assessed the 2-year risk of major adverse cardiac events (MACE: Death, myocardial infarction, or stent thrombosis) and bleeding by constructing Kaplan-Meier curves and fitting unadjusted and adjusted Cox proportional hazards models. We assessed the influence of DES generation and PR on the effect of CAC on outcomes by including interaction terms in the models. RESULTS: CAC was present in 2644 (30.8%) patients. Age, smoking, hypertension, hyperlipidemia, insulin-treated diabetes, hemodialysis, and peripheral artery disease were independent predictors of CAC. Having a CAC was associated with increased unadjusted and adjusted hazards for 2-year MACE and bleeding. The association between CAC and ischemic outcomes was consistent across DES generations and PR (pinteraction>0.05). CONCLUSION: Contemporary DES PCI of calcified lesions is common and is associated with an increased risk of ischemic and bleeding complications.
BACKGROUND: Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is common and has been historically associated with an increased risk of adverse events. Whether the association between target lesion calcification (CAC) and outcomes differ across drug-eluting stent generation or between patients with high vs. low residual platelet reactivity (PR) remains unknown. We assessed the association of CAC with adverse ischemic and bleeding events among patients undergoing contemporary PCI with drug-eluting stents (DES). METHODS: We included all 8582 patients who underwent successful PCI with DES in the prospective ADAPT-DES study. Patients were grouped according to whether or not they had CAC. We used a multivariable logistic regression analysis to determine independent predictors of CAC. We assessed the 2-year risk of major adverse cardiac events (MACE: Death, myocardial infarction, or stent thrombosis) and bleeding by constructing Kaplan-Meier curves and fitting unadjusted and adjusted Cox proportional hazards models. We assessed the influence of DES generation and PR on the effect of CAC on outcomes by including interaction terms in the models. RESULTS: CAC was present in 2644 (30.8%) patients. Age, smoking, hypertension, hyperlipidemia, insulin-treated diabetes, hemodialysis, and peripheral artery disease were independent predictors of CAC. Having a CAC was associated with increased unadjusted and adjusted hazards for 2-year MACE and bleeding. The association between CAC and ischemic outcomes was consistent across DES generations and PR (pinteraction>0.05). CONCLUSION: Contemporary DES PCI of calcified lesions is common and is associated with an increased risk of ischemic and bleeding complications.
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
Authors: Ata Doost; James Marangou; Thato Mabote; Gerald Yong; Sharad Shetty; Alan Whelan; Matthew Erickson; Michael Nguyen; Christopher Judkins; Anthony Putrino; Abdul Rahman Ihdayhid; Richard Clugston; James Rankin Journal: AsiaIntervention Date: 2022-03-15
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
Authors: Björn Redfors; Samin K Sharma; Shigeru Saito; Annapoorna S Kini; Arthur C Lee; Jeffrey W Moses; Ziad A Ali; Robert L Feldman; Rohit Bhatheja; Gregg W Stone Journal: Circ Cardiovasc Interv Date: 2020-08-06 Impact factor: 6.546