Abstract 16973: Prevalence, Determinants, and Impact of Target Lesion Calcification in Patients Undergoing Percutaneous Coronary Intervention With Newer Generation Drug Eluting Stents: Findings From a Large Multiethnic Registry
Coronary calcification increases risk for adverse events in patients undergoing PCI with bare-metal or first-generation drug-eluting stents. Newer generation devices, however, are safer and more efficacious. Whether coronary calcification relates to risk in the newer generation DES era is unclear.
We assessed the hypothesis that target lesion calcification in patients undergoing PCI with newer generation DES is associated with specific patient characteristics and clinical outcomes.
We performed a retrospective analysis of a large, multiethnic cohort of patients undergoing PCI (n=14,054) with new generation DES at a single academic center between 2009 & 2013. Coronary calcification was qualitatively assessed as none/mild, moderate or severe. Independent demographic, clinical and anatomic predictors of moderate/severe calcification were identified using logistic regression. Associations between coronary calcification and one-year MACE (death, MI or TVR) were examined using Cox modeling.
Compared to patients with none/mild (n=11,530; 82.0%) those with moderate (n=1423; 10.0%) or severe (n=1101; 8.0%) coronary calcification were older, more often Caucasian, and had more complex target lesions and greater renal dysfunction. The strongest demographic, clinical and anatomic correlates of moderate/severe calcification were Caucasian race, renal dysfunction and left main target lesion. Unadjusted MACE rates among those with none/mild, moderate and severe calcification were 9.0, 14.7, and 17.9%, respectively (p<0.001, Figure). After multivariable adjustment, hazard ratios (95% CI) for MACE associated with moderate and severe coronary calcification were 1.48 (1.27-1.72) and 1.72 (1.46-2.03), respectively.
Despite the improved safety and efficacy profile of new generation DES, moderate to severe target lesion coronary calcification is not uncommon in the contemporary DES era and remains a strong and independent predictor of MACE after PCI.
- Drug Eluting Stents
- Percutaneous Coronary Intervention
- Target vessel revascularization
- myocardial infarction
Author Disclosures: R.S. Copeland-Halperin: None. U. Baber: None. A. Rajamanickam: None. M. Aquino: None. S. Roy: None. J.C. Kovacic: None. P. Moreno: Honoraria; Modest; AstraZeneca. P. Krishnan: None. J. Sweeny: None. R. Mehran: None. G. Dangas: None. A.S. Kini: None. S.K. Sharma: None.
- © 2015 by American Heart Association, Inc.