Editorial: The Conundrum of Calcified Coronaries

Grines, Cindy L.; Kaplan, Barry M.; Singh, Varinder

doi:10.1111/joic.12371

Cited by 1 publication

(2 citation statements)

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Section: Calcified Coronariescontrasting

confidence: 99%

“…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). Although the primary outcomes were similar after propensity matched analysis, these results are in contrast with the previous belief that lesions responsible for ACS are soft, ulcerated, and non-calcified while calcified lesions are more chronic 37. A single center study of 559 patients with heavily calcified lesions found that routine, elective rotational atherectomy (RA) prior to device deployment was superior to bailout RA where RA was employed only after failure of balloon dilatation or stent delivery 38.…”

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confidence: 65%

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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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Section: Calcified Coronariescontrasting

confidence: 99%

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confidence: 65%