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Prevalence, predictors, prognostic significance, and effect of techniques on outcomes of coronary lesion calcification following implantation of drug-eluting stents: a patient-level pooled analysis of stent-specific, multicenter, prospective IRIS-DES registries

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Author(s)
Lee, Cheol HyunAhn, Jung-MinLee, Kyu SupKang, Do-YoonLee, Pil HyungLee, Seung-WhanLee, Cheol WhanPark, Seong-WookPark, Duk-WooPark, Seung-Jung
Keimyung Author(s)
Lee, Cheol Hyun
Department
Dept. of Internal Medicine (내과학)
Journal Title
Coron Artery Dis
Issued Date
2021
Volume
32
Issue
1
Keyword
coronary calcificationdrug-eluting stentspercutaneous coronary intervention
Abstract
Aims:
There is limited information on the clinical relevance and procedural impact of coronary artery calcification (CAC) in the contemporary percutaneous coronary intervention (PCI) setting. This study sought to determine the incidence and clinical significance of procedural techniques on the outcomes in 'real-world' patients with CAC undergoing PCI with drug-eluting stents (DESs).

Methods and results:
Using patient-level data from seven stent-specific, prospective DES registries, we evaluated 17 084 patients who underwent PCI with various DES types between July 2007 and July 2015. The primary outcome was target-vessel failure (TVF), defined as a composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization. Outcomes through 3 years (and between 0–1 and 1–3 years) were assessed according to CAC status (none/mild vs. moderate/severe) and stenting technique (predilation or post-dilation). Among 17 084 patients with 22 739 lesions included in the pooled dataset, moderate to severe CAC was observed in 11.3% of patients (10.1% of lesions). Older age, lower BMI, diabetes, hypertension, family history of coronary artery disease, and renal failure were independent predictors of moderate/severe CAC. The presence of moderate/severe CAC was significantly associated with an adjusted risk of TVF at 3 years [hazard ratio, 1.37; 95% confidence interval (CI), 1.19–1.58; P < 0.001]. For severe CAC, optimal lesion preparation with predilation was associated with a lower 3-year rate of TVF (no vs. yes, 22.3 vs. 12.8%), in which the effect of predilation was prominent at the late period of 1–3 years (hazard ratio, 0.28; 95% CI, 0.12–0.69; P = 0.003) than at the early period through 1 year (hazard ratio, 1.16; 95% CI, 0.37–3.71; P = 0.80). However, post-dilation (with a high-pressure noncompliant balloon) had no effect on the outcome.

Conclusions:
In this study, moderate/severe CAC was common (~10%) and strongly associated with TVF during 3 years of follow-up. For severe CAC, optimal lesion preparation with pre-balloon dilation has a significant effect on long-term outcomes, especially during the late period beyond 1 year.
Keimyung Author(s)(Kor)
이철현
Publisher
School of Medicine (의과대학)
Citation
Lee, Cheol Hyun et al. (2021). Prevalence, predictors, prognostic significance, and effect of techniques on outcomes of coronary lesion calcification following implantation of drug-eluting stents: a patient-level pooled analysis of stent-specific, multicenter, prospective IRIS-DES registries. Coron Artery Dis, 32(1), 42–50. doi: 10.1097/MCA.0000000000000896
Type
Article
ISSN
1473-5830
Source
https://journals.lww.com/coronary-artery/Fulltext/2021/01000/Prevalence,_predictors,_prognostic_significance,.8.aspx
DOI
10.1097/MCA.0000000000000896
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43595
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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