Impact of coronary artery calcification on percutaneous coronary intervention and postprocedural complications

Abazid, Rami M.; Kattea, M. Obadah; Smettei, Osama A.; Beshir, Yasir; Sakr, Haitham

doi:10.1016/j.jsha.2016.05.002

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…Previous reports have focused on outcomes after PCI for calcified lesions only in patients with stable angina 19,20 . Calcified plaques often require high‐pressure dilatation to gain an acceptable lumen area.…”

Section: Discussionmentioning

confidence: 99%

Comparison of post‐stent optical coherence tomography findings among three subtypes of calcified culprit plaques in patients with acute coronary syndrome

Nakajima

Araki

Kurihara

et al. 2020

Cathet Cardio Intervent

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Objectives To compare the postprocedural optical coherence tomography (OCT) findings and in‐hospital outcomes among the three subtypes of calcified plaques: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion. Background Recently, three subtypes of calcified culprit plaques were reported in patients with acute coronary syndrome (ACS). How these subtypes respond to stenting is unknown. Methods ACS patients with calcified plaque at the culprit lesion were selected from our database. OCT findings at baseline and after stent implantation were compared. Results In the final analysis, 87 cases were included. Preprocedural OCT showed eruptive calcified nodules in 19 (21.8%) cases, superficial calcific sheet in 63 (72.4%), and calcified protrusion in 5 (5.7%). Stent edge dissection (SED) and incomplete stent apposition (ISA) were frequently observed in the eruptive calcified nodules group compared to superficial calcific sheet or calcified protrusion (SED; 47.4% vs. 17.5% vs. 20.0%; p = .032, ISA; 94.7% vs. 58.7% vs. 0.0%; p < .001). The superficial calcific sheet group had the smallest minimal stent area (MSA) among the three groups (eruptive calcified nodules vs. superficial calcific sheet vs. calcified protrusion: 6.29 ± 2.41 vs. 4.72 ± 1.37 vs. 6.56 ± 1.13; p = .007). The superficial calcific sheet group had a higher rate of periprocedural myocardial infarction compared to the eruptive calcified nodules group (60.3% vs. 31.6%; p = .028). Conclusions This study demonstrated eruptive calcified nodules are associated with higher incidence of SED and ISA, whereas superficial calcific sheets are associated with small MSA and higher periprocedural myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

Comparison of post‐stent optical coherence tomography findings among three subtypes of calcified culprit plaques in patients with acute coronary syndrome

Nakajima

Araki

Kurihara

et al. 2020

Cathet Cardio Intervent

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“…Calcification is a special manifestation of CVD that induces major arterial stiffening and occlusions. Severe coronary artery calcification increases the risks of interventional procedures, and patients have a poor prognosis [2]. Diabetes mellitus is a primary cause of vascular calcification [3].…”

Section: Introductionmentioning

confidence: 99%

Glycemic variability is associated with vascular calcification by the markers of endoplasmic reticulum stress-related apoptosis, Wnt1, galectin-3 and BMP-2

Zhang

Sun

Liu

et al. 2019

Diabetol Metab Syndr

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Background The present study identified whether glycemic variability (GV) was associated with vascular calcification and explored the underlying mechanisms. Methods Eighty-four consecutive type 2 diabetic patients with unstable angina (UA) were included from January 2018 to June 2018 to calculate calcification scores using computerized tomographic angiography (CTA), and the patients were divided into 2 groups: high calcification score group (HCS group) and low calcification score group (LCS group). Intergroup differences in GV were determined via comparisons of the standard deviation (SD) of blood glucose. Calcification staining, content measurement, apoptosis evaluation and Western blot analysis of endoplasmic reticulum (ER) stress-related apoptosis, Wnt1, galectin-3 and bone morphogenetic protein-2 (BMP-2) were compared in cell cultures from rat vascular smooth muscle cells in the different degrees of GV. Results The SD increased significantly with the increases in calcification scores from human studies (HCS group 2.37 ± 0.82 vs. LCS group 1.87 ± 0.78, p = 0.007). Multivariate logistic regression analysis suggested that increased SD and serum creatinine were independent predictors of calcification. The high GV group had a higher apoptotic rate, higher calcification content and higher expressions of glucose-regulated protein, caspase-3, Wnt1, galectin-3 and BMP-2 markers compared to the low GV group in the in vitro studies ( p < 0.001). Conclusion We report the novel finding that GV is associated with vascular calcification, and ER stress-related apoptosis, Wnt1, galectin-3 and BMP-2 may be involved in this regulation.

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“…Previous report demonstrated that sustained severe dissection occurred in 1.4% among 3622 PCIs to complex lesions (thrombus, calcification, bifurcation or CTO) [ 34 ]. As for calcification lesions, coronary dissections which required further stent deployment or prolonged balloon inflation occurred in 4.8% of PCI to severe calcificated lesions [ 35 ]. Although the definition of complex PCI and coronary dissection were different from the definitions in these reports, the incidence of severe CICAD in patients with complex PCI was 1.6% in our registry, which was similar to the previously reported incidence.…”

Section: Discussionmentioning

confidence: 99%

Impact of catheter-induced iatrogenic coronary artery dissection with or without postprocedural flow impairment: A report from a Japanese multicenter percutaneous coronary intervention registry

et al. 2018

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Despite the ever-increasing complexity of percutaneous coronary intervention (PCI), the incidence, predictors, and in-hospital outcomes of catheter-induced coronary artery dissection (CICAD) is not well defined. In addition, there are little data on whether persistent coronary flow impairment after CICAD will affect clinical outcomes. We evaluated 17,225 patients from 15 participating hospitals within the Japanese PCI registry from January 2008 to March 2016. Associations between CICAD and in-hospital adverse cardiovascular events were evaluated using multivariate logistic regression. Outcomes of patients with CICAD with or without postprocedural flow impairment (TIMI flow ≤ 2 or 3, respectively) were analyzed. The population was predominantly male (79.4%; mean age, 68.2 ± 11.0 years); 35.6% underwent PCI for complex lesions (eg. chronic total occlusion or a bifurcation lesion.). CICAD occurred in 185 (1.1%), and its incidence gradually decreased (p < 0.001 for trend); postprocedural flow impairment was observed in 43 (23.2%). Female sex, complex PCI, and target lesion in proximal vessel were independent predictors (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.53–3.10; OR, 2.19; 95% CI, 1.58–3.04; and OR, 1.55; 95% CI, 1.06–2.28, respectively). CICAD was associated with an increased risk of in-hospital adverse events (composite of new-onset cardiogenic shock and new-onset heart failure) regardless of postprocedural flow impairment (OR, 10.9; 95% CI, 5.30–22.6 and OR, 2.27; 95% CI, 1.20–4.27, respectively for flow-impaired and flow-recovered CICAD). In conclusion, CICAD occurred in roughly 1% of PCI cases; female sex, complex PCI, and proximal lesion were its independent risk factors. CICAD was associated with adverse in-hospital cardiovascular events regardless of final flow status. Our data implied that the appropriate selection of PCI was necessary for women with complex lesions.

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Impact of coronary artery calcification on percutaneous coronary intervention and postprocedural complications

Abstract: CCS measured by MDCT has an important role in predicting early, but not late, complications from PCI.

Cited by 10 publications

References 28 publications

Comparison of post‐stent optical coherence tomography findings among three subtypes of calcified culprit plaques in patients with acute coronary syndrome

Comparison of post‐stent optical coherence tomography findings among three subtypes of calcified culprit plaques in patients with acute coronary syndrome

Glycemic variability is associated with vascular calcification by the markers of endoplasmic reticulum stress-related apoptosis, Wnt1, galectin-3 and BMP-2

Impact of catheter-induced iatrogenic coronary artery dissection with or without postprocedural flow impairment: A report from a Japanese multicenter percutaneous coronary intervention registry

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