Abstract 19098: Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: From the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration
Background: Clinical correlates and prognostic significance of coronary artery calcifications (CAC) in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remain unclear.
Objectives: We sought to investigate the clinical correlates and prognostic impact of CAC in women undergoing PCI with DES.
Methods: We pooled patient-level data of female participants from 26 randomized trials of DES. Study population was categorized according to the presence of moderate or severe versus mild or none target lesion CAC, assessed through coronary angiography. Co-primary endpoints of interest were the composite of death, myocardial infarction (MI) or target lesion revascularization (TLR) and death, MI or stent thrombosis (ST) at 3 years of follow-up.
Results: Out of 11,557 women included in the pooled dataset, CAC status was available in 6,371 women. Of these, 1,622 (25.5%) had moderate or severe CAC. In fully adjusted models, independent correlates of CAC were age, hypertension, hypercholesterolemia, smoking, previous coronary artery by-pass graft surgery, lower left ventricular ejection fraction and higher serum creatinine. ST-segment elevation MI was associated with lower likelihood of CAC. At 3 years (Figure), women with CAC were at higher risk of death, MI or TLR (18.2% vs. 13.1%; adjusted hazard ratio [HR]: 1.56; 95% confidence interval [CI]: 1.33-1.84; p<0.0001) and death, MI or ST (12.7% vs. 8.6%; adjusted HR: 1.48; 95% CI: 1.21-1.80; p=0.0001). The adverse effect of CAC on ischemic outcomes appeared to be consistent across clinical and angiographic subsets of women, including new-generation DESs.
Conclusion: Women undergoing PCI of calcified lesions tend to have worse clinical profile and remain at increased ischemic risk. The adverse effect of CAC on outcomes appeared to be consistent even with use of new-generation DES. Additional measures are needed to improve suboptimal PCI outcomes in this high-risk subset of patients.
- Percutaneous coronary intervention (PCI)
- Coronary artery calcification (CAC)
- Drug eluting stents
Author Disclosures: G. Giustino: None. U. Baber: None. S. Sartori: None. G.W. Stone: None. M.B. Leon: None. S. Windecker: None. M. Valgimigli: Honoraria; Significant; Merck, Iroko, Eli Lilly, Medtronic, Medicines Company, Daiichi Sankyo, St Jude, Abbott Vascular, Cordis, Carbostent and Implantable Devices, Terumo. A. Kastrati: Honoraria; Significant; Abbott, Biosensors, Biotronik, Cordis, Medtronic. Other; Significant; Patent application in respect of a biodegradable polymer stent coating. P.W. Serruys: None. G. Steg: Research Grant; Significant; Servier, Sanofi. Ownership Interest; Significant; Aterovax. Consultant/Advisory Board; Significant; Amarin, AstraZeneca, Bayer, Boehringer-Ingelheim, BristolMyersSquibb, Daiichi-Sankyo, GalaxoSmithKline, Janssen, Lilly, Medtronic, Merck-Sharpe, Dohme, Novartis, Orexigen, Pfizer, Regado, Sanofi, Servier, The Medicines Company. M. Aquino: None. G. Danias: None. M. Morice: None. P.C. Smits: Research Grant; Significant; Abbott Vascular, Boston Scientific, St Jude, Terumo. D. Kandzari: Research Grant; Significant; Medtronic, Abbott, Boston Scientific. Honoraria; Significant; Medtronic, Boston Scientific. C. Von Birgelen: Research Grant; Significant; Abbott Vascular, Biotronik, Boston Scientific, Medtronic. Consultant/Advisory Board; Significant; Abbott Vascular, Biotronik, Boston Scientific, Medtronic, Merck Sharp and Dohme. G. Dangas: Research Grant; Significant; Medicines Company, Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, AstraZeneca. Consultant/Advisory Board; Significant; AstraZeneca, Bayer, CSL Behring, Janssen Pharmaceuticals, Merck, Osprey Medical, Watermark Research Partners, Abbott Laboratories, Boston Scientific, Coviden, Medicines Company, Sanofi-Aventis. S. Galatius: Research Grant; Significant; St Jude, Abbott, Terumo, Biotronik. Consultant/Advisory Board; Significant; Eli Lilly, Servier. T. Kimura: None. A. Chieffo: None. R. Mehran: Research Grant; Significant; Medicines Company, Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, AstraZeneca. Consultant/Advisory Board; Significant; AstraZeneca, Bayer, CSL Behring, Janssen Pharmaceuticals, Merck, Osprey Medical, Watermark Research Partners, Abbott Laboratories, Boston Scientific, Coviden, Medicines Company, Sanofi-Aventis.
- © 2016 by American Heart Association, Inc.