Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer‐generation DES: Findings from a large multiethnic registry

Copeland‐Halperin, Robert S.; Baber, Usman; Aquino, Melissa; Rajamanickam, Anitha; Roy, Satyajeet; Hasan, Choudhury; Barman, Nitin; Kovacic, Jason C.; Moreno, Pedro R.; Ramanathan, Krishnan; Sweeny, Joseph; Mehran, Roxana; Dangas, George; Kini, Annapoorna; Sharma, Samin K.

doi:10.1002/ccd.27204

Cited by 79 publications

(55 citation statements)

References 24 publications

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“…A large multiethnic registry retrospectively assessed patients, who had undergone stent implantation between 2009 and 2013, according to coronary calcification 24 . A total of 994 (8.0%) of these patients were treated with second‐generation durable polymer DES for severely calcified lesions, and the 1‐year incidence of the composite clinical endpoint of death, myocardial infarction, or TVR (17.8%) was much higher than the 2‐year incidence of target vessel failure in our current study.…”

Section: Discussionmentioning

confidence: 99%

Three contemporary thin‐strut drug‐eluting stents implanted in severely calcified coronary lesions of participants in a randomized all‐comers trial

Buiten

Ploumen

Zocca

et al. 2020

Cathet Cardio Intervent

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Objective The objective was to assess the 2‐year clinical performance of three drug‐eluting stents in all‐comer patients with severely calcified coronary lesions. Background Severe lesion calcification increases cardiovascular event risk after coronary stenting, but there is a lack of data on the clinical outcome of all‐comers with severely calcified lesions who were treated with more recently introduced drug‐eluting stents. Methods The BIO‐RESORT trial (http://clinicaltrials.gov: NCT01674803) randomly assigned 3,514 all‐comer patients to biodegradable polymer Synergy everolimus‐eluting stents (EES) or Orsiro sirolimus‐eluting stents (SES), versus durable polymer Resolute Integrity zotarolimus‐eluting stents (ZES). In a post hoc analysis, we assessed 783 patients (22.3%) with at least one severely calcified target lesion. Results At 2‐year follow‐up (available in 99% of patients), the main composite endpoint target vessel failure occurred in 19/252 (7.6%) of the EES and in 33/265 (12.6%) of the ZES‐treated patients (p = .07). Target vessel failure occurred in 24/266 (9.1%) of the SES‐treated patients (vs. ZES: p = .21). There was a difference in target vessel revascularization, which was required in EES in 6/252 (2.4%) patients and in ZES in 20/265 (7.7%) patients (p = .01); the target vessel revascularization rate in SES was 9/266 (3.4%, vs. ZES: p = .04). Multivariate analysis showed that implantation of EES, but not SES, was independently associated with lower target vessel revascularization rates than in ZES. Conclusions In BIO‐RESORT participants with severely calcified target lesions, treatment with EES was associated with a lower 2‐year target vessel revascularization rate than treatment with ZES.

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Section: Discussionmentioning

confidence: 99%

Three contemporary thin‐strut drug‐eluting stents implanted in severely calcified coronary lesions of participants in a randomized all‐comers trial

Buiten

Ploumen

Zocca

et al. 2020

Cathet Cardio Intervent

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“…The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is the method utilized to evaluate coronary disease's complexity. The primary factors of high scores are the sites and severity of lesions [13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Current Treatment Modalities for Calcified Coronary Artery Disease: A Review Article Comparing Novel Intravascular Lithotripsy and Traditional Rotational Atherectomy

Kaul¹,

Dhalla²,

Bapatla³

et al. 2020

Cureus

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The coronary artery calcium score is considered the most useful marker for predicting coronary events. The high score reflects heavy calcification in the vessel, which is more challenging to treat with the percutaneous intervention (PCI). To prepare this type of heavily calcified lesion intravascular lithotripsy (IVL) technology can be used prior to PCI, which is based on the concept of converting electrical energy into mechanical energy. It harmlessly and selectively disrupts both the shallow and deep deposits of calcium. The balloonbased catheters of this system emit sonic waves that transfer to the adjacent tissue resulting in improvement in vessel compliance with the slightest soft tissue loss. Therefore, making the treatment of calcified lesions more feasible, effective, and also simplify complex lesions. The lesions considered for lithotripsy-enhanced balloon dilation include calcified coronary lesions and peripheral vasculature lesions. This article reviews the use of IVL in calcified coronary artery disease, its advantages, and disadvantages while comparing it with other techniques like high-pressure balloons and rotational atherectomy devices. A thorough search of databases like PubMed and Google Scholar was performed, which uncovered 35 peer review articles. Keywords utilized in the data search were calcified coronary artery disease, coronary lithotripsy, calcification, and calcified atherosclerotic plaque. According to rotational atherectomy and intravascular lithotripsy trials, the latter was safer, mainly by decreasing atheromatous embolization risk. Deciphering these studies, it seems like IVL is better at parameters like procedural and clinical success rate, acute lumen gain, and less residual stenosis except in-hospital major adverse cardiovascular events (MACE), which was better in rotational atherectomy (RA). However, when lesion crossings are present, the atherectomy technique is still considered as first-line therapy. In clinical practice, despite these encouraging data for treating calcified lesions, IVL is grossly underutilized because of substantial costs and perceived significant procedural risk effects on the cardiac rhythm like causing 'shock topics' and asynchronous cardiac pacing. More longer-term clinical data and extensive researches are required to validate its safety and efficiency.

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“…Trials assessing the impact of calcium are often retrospective, include pooled subjects from multiple trials, combine moderate and severe calcium, or use investigator reported calcification . In contrast, the MACE‐Trial was intended to provide a standardized assessment of outcomes in subjects treated with standard‐of‐care PCI techniques stratified by lesion calcification.…”

Section: Discussionmentioning

confidence: 99%

“…One‐year MACE‐Trial outcomes were different from other contemporary studies that indicate that moderate calcium negatively impacts outcomes. Pooled data from ACUITY and HORIZONS‐AMI demonstrated that in addition to severe calcification, moderate calcification did have a significant impact on 1‐year MACE (19.9% and 15.3%, respectively) as compared to none/mild (12.9%); reported outcomes in Copeland‐Halperin et al (8.3% none/mild, 14.6% moderate, and 17.7% severe) resulted in a similar conclusion . Additionally, compared to Copeland‐Halperin et al, the MACE‐Trial reported lower rates of 1‐year MACE for none/mild and moderate, but outcomes for severely calcified subjects were considerably higher.…”

Section: Discussionmentioning

confidence: 99%

Impact of calcification on percutaneous coronary intervention: MACE‐Trial 1‐year results

Sharma

Bolduan

Patel

et al. 2019

Cathet Cardio Intervent

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Objectives The Multi‐center Prospective Study to Evaluate Outcomes of Moderate to Severely Calcified Coronary Lesions (MACE—Trial) was designed to provide further insight on the impact of calcification on procedural and long‐term percutaneous coronary intervention outcomes. Background Prior studies evaluating the impact of lesion calcification on percutaneous coronary intervention outcomes are limited by: retrospective nature, pooled data from multiple studies, or lack of specificity around calcification with only operator assessment and without core lab evaluation. Methods The MACE‐Trial was a prospective, multicenter, observational clinical study that enrolled 350 subjects at 33 sites from September 2013 to September 2015. Core lab assessed subject stratification by lesion calcification (none/mild [N = 133], moderate [N = 99], and severe [N = 114]). Endpoints were lesion success, procedural success, and 1‐year major adverse cardiac events (MACEs). Results Presence of severe calcification had significant impact on lesion success ([83.3%] versus none/mild calcification [94.7%, P = 0.006]) and procedural success ([86.8%] versus moderate [95.0%, P = 0.028], and none/mild [97.7%, P = 0.001]). 1‐year MACE rates were associated with presence of calcification in subjects with none/mild (4.7%), moderate (8.7%), and severe (24.4%) (P < 0.001) calcification; however, no difference was noted between none/mild and moderate (P = 0.237). The risk adjusted multivariable model identified severe calcification and decreasing eGFR as predictors of 30‐day and 1‐year MACE. Conclusions In this prospective study, patients with severe calcification had significantly worse outcomes compared to those without; however, unlike previous retrospective studies, moderate calcium resulted in similar outcomes as none/mild calcium. Clinical Trial Registration URL: https://clinicaltrials.gov/ct2/show/NCT01930214. Unique Identifier: NCT01930214.

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Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer‐generation DES: Findings from a large multiethnic registry

Abstract: Target lesion calcification remains independently associated with adverse outcomes in patients treated with newer generation DES and modern devices.

Cited by 79 publications

References 24 publications

Three contemporary thin‐strut drug‐eluting stents implanted in severely calcified coronary lesions of participants in a randomized all‐comers trial

Three contemporary thin‐strut drug‐eluting stents implanted in severely calcified coronary lesions of participants in a randomized all‐comers trial

Current Treatment Modalities for Calcified Coronary Artery Disease: A Review Article Comparing Novel Intravascular Lithotripsy and Traditional Rotational Atherectomy

Impact of calcification on percutaneous coronary intervention: MACE‐Trial 1‐year results

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