Abstract 13723: Does Presence of Fluoroscopic Coronary Artery Calcification Affect the Clinical Outcome of Patients Undergoing Percutaneous Coronary Intervention? Results from the Intermountain Heart Collaborative Study Registry
BACKGROUND: The technical approach to, and difficulty of, percutaneous coronary intervention (PCI) among pts with CAD may be profoundly affected by the amount of coronary calcification (CAC) present. For instance, heavy CAC may require the use of rotational coronary atherectomy, make appropriate positioning of coronary stents problematic, or prevent full stent expansion during deployment. However, although these technical challenges may make the initial PCI procedure more difficult, how the presence of significant CAC affects the long term outcome of PCI is poorly known.
METHODS: We analyzed the coronary angiograms of 592 pts undergoing PCI and enrolled in the Intermountain Heart Collaborative Study catheterization registry. To assess angiographic severity of fluoroscopic CAC (F-CAC), we developed a novel scoring system, reporting extent (0-3) and severity (0-3) for each major coronary vessel (LM, LAD, LCX, RCA). A global score was determined by multiplying extent and severity scores for each vessel and summing the numbers for the 4 vessels (range=0-27). Pts undergoing PCI were then stratified by the presence of calcification (F-CAC ≥1). Multivariate logistic regression was performed to determine the independent effect of F-CAC on acute procedural success and 1 yr death, myocardial infarction (MI) and repeat coronary revascularization (Revasc).
RESULTS: Pts with F-CAC were older (67±11 yrs vs 62±12 yrs, p>0.0001), more often smokers (23.9% vs 16.6%, p=0.03) and more frequently had multi-vessel CAD (52.1% vs 39.8%, p=0.04). Stents were used in 88% of cases and did not differ between groups. Rotational atherectomy was used more frequently (6.7% vs 3.0%, p=0.5) in patients with F-CAC. Acute success was high and did not differ between pts with and without F-CAC (100% vs 98.5%, p=NS). Even after adjustment, there was no difference in the 1 yr outcomes of death (3.2% vs 2.7%, odds ratio (OR) = 1.19, p=0.71), MI (11.2% vs 12.1%, OR=0.99, p=0.97), Revasc (20.0% vs 18.6%, OR=1.05, p=0.84) or the combination of events (28.2% vs 27.7%, OR=1.0, p=0.99). Results were similar even for those with F-CAC ≥3.
CONCLUSIONS: Although coronary calcification may increase the technical difficulty of PCI, it has no effect on the ultimate acute success or long-term outcome of PCI.
- © 2012 by American Heart Association, Inc.