Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials

Bourantas, Christos V; Zhang, Yao-Jun; Garg, Scot; Iqbal, Javaid; Valgimigli, Marco; Windecker, Stephan; Mohr, Friedrich W; Silber, Sigmund; Vries, Ton de; Onuma, Yoshinobu; Garcia Garcia, Hector Manuel; Morel, Marie-Angele; Serruys, Patrick W (2014). Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart (British Cardiac Society), 100(15), pp. 1158-1164. BMJ Publishing Group 10.1136/heartjnl-2013-305180

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OBJECTIVE To investigate the long-term prognostic implications of coronary calcification in patients undergoing percutaneous coronary intervention for obstructive coronary artery disease. METHODS Patient-level data from 6296 patients enrolled in seven clinical drug-eluting stents trials were analysed to identify in angiographic images the presence of severe coronary calcification by an independent academic research organisation (Cardialysis, Rotterdam, The Netherlands). Clinical outcomes at 3-years follow-up including all-cause mortality, death-myocardial infarction (MI), and the composite end-point of all-cause death-MI-any revascularisation were compared between patients with and without severe calcification. RESULTS Severe calcification was detected in 20% of the studied population. Patients with severe lesion calcification were less likely to have undergone complete revascularisation (48% vs 55.6%, p<0.001) and had an increased mortality compared with those without severely calcified arteries (10.8% vs 4.4%, p<0.001). The event rate was also high in patients with severely calcified lesions for the combined end-point death-MI (22.9% vs 10.9%; p<0.001) and death-MI- any revascularisation (31.8% vs 22.4%; p<0.001). On multivariate Cox regression analysis, including the Syntax score, the presence of severe coronary calcification was an independent predictor of poor prognosis (HR: 1.33 95% CI 1.00 to 1.77, p=0.047 for death; 1.23, 95% CI 1.02 to 1.49, p=0.031 for death-MI, and 1.18, 95% CI 1.01 to 1.39, p=0.042 for death-MI- any revascularisation), but it was not associated with an increased risk of stent thrombosis. CONCLUSIONS Patients with severely calcified lesions have worse clinical outcomes compared to those without severe coronary calcification. Severe coronary calcification appears as an independent predictor of worse prognosis, and should be considered as a marker of advanced atherosclerosis.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan and Garcia Garcia, Hector Manuel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1468-201X

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Judith Liniger

Date Deposited:

09 Feb 2015 14:44

Last Modified:

28 Oct 2015 11:44

Publisher DOI:

10.1136/heartjnl-2013-305180

PubMed ID:

24846971

BORIS DOI:

10.7892/boris.62124

URI:

https://boris.unibe.ch/id/eprint/62124

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