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Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS.
J Am Coll Cardiol 2014; 63(18):1845-54JACC

Abstract

OBJECTIVES

This study sought to determine the frequency and impact of coronary calcification among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS).

BACKGROUND

Small studies in patients with stable coronary artery disease have suggested a worse prognosis after PCI of calcified compared with noncalcified lesions. Little is known about the impact of coronary calcification on outcomes after PCI for patients presenting with non-ST-segment elevation and ST-segment elevation ACS.

METHODS

Data from 6,855 patients presenting with ACS in whom PCI was performed were pooled from 2 large-scale randomized, controlled trials, ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) and HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction). One-year outcomes were analyzed according to the severity of PCI target lesion calcification (none/mild, moderate, or severe) as assessed by an independent angiographic core laboratory.

RESULTS

Target lesion calcification was severe in 402 patients (5.9%), moderate in 1,788 (26.1%), and none/mild in 4,665 (68.1%). Moderate/severe target lesion calcification was more frequent in older patients, men, hypertensive patients, and those presenting with ST-segment elevation myocardial infarction (STEMI). The unadjusted 1-year rates of death, cardiac death, definite stent thrombosis, and ischemic target lesion revascularization (TLR) and target vessel revascularization were significantly increased in patients with moderate/severe target lesion calcification. By multivariable analysis, the presence of moderate/severe target lesion calcification was an independent predictor of 1-year definite stent thrombosis (hazard ratio [HR]: 1.62; 95% confidence interval [CI]: 1.14 to 2.30; p = 0.007) and ischemic TLR (HR: 1.44; 95% CI: 1.17 to 1.78; p = 0.0007).

CONCLUSIONS

Moderate/severe lesion calcification was relatively frequent in patients with non-ST-segment elevation ACS and STEMI and was strongly predictive of stent thrombosis and ischemic TLR at 1 year. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158; Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966).

Authors+Show Affiliations

New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada.New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York.New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.Istituto di Cardiologia, University of Bologna, Bologna, Italy.Cardiovascular Research Foundation, New York, New York.Cardiovascular Research Foundation, New York, New York.Cardiovascular Research Foundation, New York, New York.New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.Yale School of Medicine, New Haven, Connecticut.Cardiovascular Research Foundation, New York, New York; New York Methodist Hospital, New York, New York.Cardiovascular Research Foundation, New York, New York; Mount Sinai Medical Center, New York, New York.New York-Presbyterian Hospital and Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

24561145

Citation

Généreux, Philippe, et al. "Ischemic Outcomes After Coronary Intervention of Calcified Vessels in Acute Coronary Syndromes. Pooled Analysis From the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS." Journal of the American College of Cardiology, vol. 63, no. 18, 2014, pp. 1845-54.
Généreux P, Madhavan MV, Mintz GS, et al. Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J Am Coll Cardiol. 2014;63(18):1845-54.
Généreux, P., Madhavan, M. V., Mintz, G. S., Maehara, A., Palmerini, T., Lasalle, L., ... Stone, G. W. (2014). Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. Journal of the American College of Cardiology, 63(18), pp. 1845-54. doi:10.1016/j.jacc.2014.01.034.
Généreux P, et al. Ischemic Outcomes After Coronary Intervention of Calcified Vessels in Acute Coronary Syndromes. Pooled Analysis From the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J Am Coll Cardiol. 2014 May 13;63(18):1845-54. PubMed PMID: 24561145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. AU - Généreux,Philippe, AU - Madhavan,Mahesh V, AU - Mintz,Gary S, AU - Maehara,Akiko, AU - Palmerini,Tullio, AU - Lasalle,Laura, AU - Xu,Ke, AU - McAndrew,Tom, AU - Kirtane,Ajay, AU - Lansky,Alexandra J, AU - Brener,Sorin J, AU - Mehran,Roxana, AU - Stone,Gregg W, Y1 - 2014/02/19/ PY - 2013/06/19/received PY - 2014/01/05/revised PY - 2014/01/06/accepted PY - 2014/2/25/entrez PY - 2014/2/25/pubmed PY - 2014/6/20/medline KW - NSTEMI KW - PCI KW - STEMI KW - coronary calcification SP - 1845 EP - 54 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 63 IS - 18 N2 - OBJECTIVES: This study sought to determine the frequency and impact of coronary calcification among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). BACKGROUND: Small studies in patients with stable coronary artery disease have suggested a worse prognosis after PCI of calcified compared with noncalcified lesions. Little is known about the impact of coronary calcification on outcomes after PCI for patients presenting with non-ST-segment elevation and ST-segment elevation ACS. METHODS: Data from 6,855 patients presenting with ACS in whom PCI was performed were pooled from 2 large-scale randomized, controlled trials, ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) and HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction). One-year outcomes were analyzed according to the severity of PCI target lesion calcification (none/mild, moderate, or severe) as assessed by an independent angiographic core laboratory. RESULTS: Target lesion calcification was severe in 402 patients (5.9%), moderate in 1,788 (26.1%), and none/mild in 4,665 (68.1%). Moderate/severe target lesion calcification was more frequent in older patients, men, hypertensive patients, and those presenting with ST-segment elevation myocardial infarction (STEMI). The unadjusted 1-year rates of death, cardiac death, definite stent thrombosis, and ischemic target lesion revascularization (TLR) and target vessel revascularization were significantly increased in patients with moderate/severe target lesion calcification. By multivariable analysis, the presence of moderate/severe target lesion calcification was an independent predictor of 1-year definite stent thrombosis (hazard ratio [HR]: 1.62; 95% confidence interval [CI]: 1.14 to 2.30; p = 0.007) and ischemic TLR (HR: 1.44; 95% CI: 1.17 to 1.78; p = 0.0007). CONCLUSIONS: Moderate/severe lesion calcification was relatively frequent in patients with non-ST-segment elevation ACS and STEMI and was strongly predictive of stent thrombosis and ischemic TLR at 1 year. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158; Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/24561145/Ischemic_outcomes_after_coronary_intervention_of_calcified_vessels_in_acute_coronary_syndromes__Pooled_analysis_from_the_HORIZONS_AMI__Harmonizing_Outcomes_With_Revascularization_and_Stents_in_Acute_Myocardial_Infarction__and_ACUITY__Acute_Catheterization_and_Urgent_Intervention_Triage_Strategy__TRIALS_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(14)00451-3 DB - PRIME DP - Unbound Medicine ER -