Impact of Calcified Target Lesions on the Outcome of Percutaneous Coronary Intervention for Acute Coronary Syndrome: Insights From the BASE ACS Trial

Karjalainen, Pasi P.; Nammas, Wail; Kervinen, Kari; Belder, Adam de; Rivero‐Crespo, Fernando; Ylitalo, Antti; Airaksinen, Juhani

doi:10.1111/joic.12357

Cited by 4 publications

(4 citation statements)

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“…However, in this issue of the Journal, among an ACS trial of 827 patients, 43% were found to have moderate to severe calcified target lesions. 1 As expected, patients with calcified lesions were older, and more likely to have hypertension, diabetes, peripheral disease and prior stroke. Surprisingly, procedure success was similar in both groups but calcified lesions required more frequent pre-and post-dilation.…”

supporting

confidence: 59%

“…In the past it has been thought that calcified lesions were chronic, and lesions responsible for acute coronary syndromes (ACS) were typically soft, ulcerated, non‐calcified lesions. However, in this issue of the Journal, among an ACS trial of 827 patients, 43% were found to have moderate to severe calcified target lesions . As expected, patients with calcified lesions were older, and more likely to have hypertension, diabetes, peripheral disease and prior stroke.…”

mentioning

confidence: 58%

“…These four new studies published in the Journal suggest combined therapy with atherectomy and DES or DCB is safe and effective in the management of calcified lesions.…”

mentioning

confidence: 99%

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Editorial: The Conundrum of Calcified Coronaries

Grines

Kaplan

Singh

2017

J Interven Cardiology

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supporting

confidence: 59%

mentioning

confidence: 58%

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Editorial: The Conundrum of Calcified Coronaries

Grines

Kaplan

Singh

2017

J Interven Cardiology

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“…Management of calcified coronary arteries remains challenging given difficulty with lesion severity assessment and higher risks of adverse outcomes with lesion manipulation. Outcomes from the BASE‐ACS trial found that of 827 patients undergoing PCI, 43% were found to have moderate to severe calcified target lesions based on visual assessment by coronary angiography . At 5 year follow up, there was an increased incidence of MACE in patients with calcified lesions (19.6% vs 12.6%, P = 0.004).…”

Section: Calcified Coronariesmentioning

confidence: 99%

Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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In an effort to keep the interventional community up-to-date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to 2 The overall rate of complete revascularization (CR) was 61.7%.In those patients with CR, there was no difference between CABG or PCI regarding death from any cause as well as composite of death, MI, and stroke at 5 year follow up, even at higher SYNTAX scores.However, compared to CABG with CR, PCI with incomplete revascularization put patients at a significant higher risk for similar endpoints. These studies suggest that the ability to achieve CR should be strongly considered when deciding between CABG and PCI in MVD.As we have learned from contemporary data on revascularization, certain subsets of patients have fared better with one revascularization strategy over another. An observational cohort study of multiple Swedish registries found that in patients with Type 1 diabetes and MVD, first multi-vessel revascularization with PCI was associated with higher risk of cardiac death, MI, and repeat revascularization although with similar all-cause mortality when compared to CABG. 3 This study indicates that CABG may be the preferred strategy in patients with Type 1 diabetes in need of multi-vessel revascularization, and is in agreement with earlier trials showing most of the benefit in patients treated with insulin, but not oral agents.In patients with low or intermediate SYNTAX score, PCI of unprotected left main with everolimus-eluting stents (EES) was shown to be noninferior to CABG with respect to a composite endpoint of death, stroke, and MI at 3 years in the EXCEL trial. 4 Of the 1905 patients randomized during the trial, 1788 patients were also followed for quality of life assessment to fully understand patient's perspective.

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