Impact of Calcified Target Lesions on the Outcome of Percutaneous Coronary Intervention for Acute Coronary Syndrome: Insights From the BASE ACS Trial.
J Interv Cardiol
; 30(2): 114-123, 2017 Apr.
Article
in En
| MEDLINE
| ID: mdl-27925308
ABSTRACT
OBJECTIVES:
We performed a post hoc analysis of outcome in patients with, versus those without, calcified target lesions from the BASE ACS trial.BACKGROUND:
The outcome of contemporary stent implantation in patients with calcified lesions presenting with acute coronary syndrome is unknown.METHODS:
The BASE ACS trial randomized 827 patients (11) presenting with acute coronary syndrome to receive either titanium-nitride-oxide-coated stents or everolimus-eluting stents. Calcified lesions were defined as moderate or severe calcification in the vessel wall by coronary angiography. The primary endpoint was major adverse cardiac events (MACE) a composite of cardiac death, non-fatal myocardial infarction or ischemia-driven target lesion revascularization. Follow-up was planned at 12 months, and yearly thereafter for up to 7 years.RESULTS:
Of 827 patients enrolled in the trial, 352 (42.6%) had calcified target lesions. Median follow-up was 5.0 years. The incidence of MACE was higher in patients with, versus those without, calcified target lesions (19.6% vs. 12.2%, respectively, P = 0.004). This was driven by more frequent cardiac death and non-fatal myocardial infarction events (P < 0.05, both). The rates of ischemia-driven target lesion revascularization were comparable (P > 0.05). MACE and the other endpoints were comparable between the 2 propensity-score matched subgroups (P > 0.05 for all). Hypertension and smaller vessel size independently predicted MACE in patients treated for calcified lesions.CONCLUSIONS:
Patients presenting with acute coronary syndrome who were treated for calcified lesions had worse long-term clinical outcome, compared with those treated for non-calcified lesions, mainly due to more frequent safety events. In the propensity score-matched analysis, the outcome was comparable.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Stents
/
Acute Coronary Syndrome
/
Vascular Calcification
/
Percutaneous Coronary Intervention
Type of study:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Interv Cardiol
Journal subject:
CARDIOLOGIA
Year:
2017
Type:
Article
Affiliation country:
Finland