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, Yaojun; Garg, Scot; Iqbal, Javaid; Valgimigli, Marco; Windecker, Stephan; Mohr, Friedrich W.; Silber, Sigmund; Vries, Ton de; Onuma, Yoshinobu; García‐García, Héctor M.; Morel, Marie‐Angèle; Serruys, Patrick W.

doi:10.1136/heartjnl-2013-305180

Cited by 240 publications

(175 citation statements)

References 30 publications

(22 reference statements)

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“…The reported frequency of severe CAC in patients undergoing PCI due to stable coronary artery disease (CAD) and ACS differs between publications and ranges from 5.9% to 20% [4,9]. In our study 17% of patients had severe CAC in target lesions, which is comparable with reports regarding patients undergoing PCI due to stable CAD, and rather high for patients with ACS.…”

Section: Discussionsupporting

confidence: 84%

“…Previous studies showed unfavourable prognosis in patients with CAC in short term; however, most of these reports were meta-analyses or pooled analyses from randomised trials with one-year follow-up [3,4,9]. The present study is the first, to our knowledge, examining clinical outcomes of patients with severe CAC undergoing PCI due to MI in long-term follow-up.…”

Section: Discussionmentioning

confidence: 90%

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Patients with acute myocardial infarction and severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis

Zimoch

Kübler²,

Kosowski³

et al. 2017

Kardiol Pol

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A b s t r a c t Background:To assess the influence of severe target lesion calcification (TLC) on the outcomes of patients undergoing percutaneous coronary interventions (PCI) due to acute myocardial infarction (AMI).Aim: Contemporary data concerning coronary artery calcifications (CAC) are based on pooled analyses from randomised trials with short follow-up. We still lack the knowledge on how CAC in target lesions affect long-term prognosis of patients with AMI in everyday practice. Methods:We evaluated clinical and laboratory data of 206 consecutive patients who underwent coronary angiography and PCI due to AMI. Primary endpoints were all-cause death and recurrent hospitalisations due to acute coronary syndrome (ACS). Results:Severe TLC lesions were present in 17% of patients. These patients were older (71 vs. 65 years, p = 0.02) and more often diagnosed with non-ST segment elevation myocardial infarction (77% vs. 58%, p = 0.03). Patients with severe TLC had lower rates of PCI success (80% vs. 97%, p < 0.0001) and less often achieved full revascularisation during index procedure (14% vs. 41%, p = 0.003). During 30 months follow-up patients with severe TLC more often suffered from another ACS (37% vs. 13%, p = 0.0005) and had higher all-cause mortality (31% vs. 16%, p = 0.04). Multivariate Cox regression model showed severe TLC to be an independent predictor of another ACS (HR 2.8; 95% CI 1.4-5.6; p = 0.004). Conclusions:Severe TLC are not uncommon in patients with ACS. The presence of severe TLC is a prognostic factor of another ACS in AMI patients undergoing PCI.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 90%

Patients with acute myocardial infarction and severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis

Zimoch

Kübler²,

Kosowski³

et al. 2017

Kardiol Pol

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“…Severe coronary calcification should be considered as a marker of advanced atherosclerosis and an independent predictor of worse prognosis [12]. PCI of calcified lesions was independently predictive of adverse ischemic outcomes, including definite stent thrombosis and unplanned ischemia driven repeat revascularization within 1 year post-PCI, as compared with patients in whom all target lesions had no or only mild calcification [13].…”

Section: Discussionmentioning

confidence: 99%

Long-term safety and performance of the orbital atherectomy system for treating calcified coronary artery lesions: 5-Year follow-up in the ORBIT I trial

Bhatt

Parikh

Patel

et al. 2015

Cardiovascular Revascularization Medicine

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“…Patients with multi-vessel disease and severely calcified lesions are less likely to have undergone complete revascularisation, 3 resulting in a higher residual Syntax score which is a powerful determinant of prognosis. 4 Both rotational atherectomy and orbital atherectomy can facilitate the device delivery and complete revascularisation, which could help achieve a lower residual Syntax score.…”

Section: Multi-vessel Disease With Severely Calcified Lesionsmentioning

confidence: 99%

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

Sotomi

Shlofmitz

Colombo

et al. 2016

Interventional Cardiology Review

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CoronaryFrom the early days of percutaneous coronary intervention (PCI) it became apparent that the presence of severe coronary calcification was a predictor of worse clinical outcomes. In the era of plain old balloon angioplasty, severe coronary calcification was associated with an increased risk of coronary dissection and procedural failure, while in the bare-metal stent era, it was associated with a higher incidence of in-stent restenosis and target lesions revascularisations (TLRs).1,2 The advent of drug-eluting stents (DES) changed the landscape of coronary intervention through the reduced risk of restenosis and TLR, thereby allowing the interventional treatment of complex lesions and high-risk patients.However, a recent patient-level pooled analysis from seven contemporary stent trials revealed that patients with severely calcified lesions still have worse clinical outcomes compared with those without severe coronary calcification.3 Patients with severe lesion calcification were less likely to have undergone complete revascularisation, resulting in a higher residual Syntax score, which is a powerful determinant of prognosis. The latest ACCF/AHA/SCAI and ESC/EACTS PCI guidelines and European expert consensus on rotational atherectomy state that rotational atherectomy has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with PCI. 7-12Rotational atherectomy should not be performed routinely for de novo lesions or in-stent restenosis. The purpose of this review is to provide insights for procedural considerations and patient selection from the currently available publications assessing the OAS. Diamondback 360 ® Coronary Orbital Atherectomy SystemThe Diamondback 360 ® Coronary OAS is the device to facilitate stent delivery in patients who are acceptable candidates for PCI due to de novo, severely calcified coronary artery lesions (see Figure 1).The Diamondback 360 ® Coronary OAS is the device to facilitate stent delivery in patients who are acceptable candidates for PCI due to AbstractDespite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging.Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy. KeywordsOrbital atherectomy system, percutaneous coronary intervention, severely calcified lesion

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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

Abstract: 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.

Cited by 240 publications

References 30 publications

Patients with acute myocardial infarction and severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis

Patients with acute myocardial infarction and severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis

Long-term safety and performance of the orbital atherectomy system for treating calcified coronary artery lesions: 5-Year follow-up in the ORBIT I trial

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

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