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- Title
Impact of Calcified Target Lesions on the Outcome of Percutaneous Coronary Intervention for Acute Coronary Syndrome: Insights From the BASE ACS Trial.
- Authors
Karjalainen, Pasi P.; Nammas, Wail; Kervinen, Kari; Belder, Adam; Rivero‐Crespo, Fernando; Ylitalo, Antti; Airaksinen, Juhani K. E.
- Abstract
<bold>Objectives: </bold>We performed a post hoc analysis of outcome in patients with, versus those without, calcified target lesions from the BASE ACS trial.<bold>Background: </bold>The outcome of contemporary stent implantation in patients with calcified lesions presenting with acute coronary syndrome is unknown.<bold>Methods: </bold>The BASE ACS trial randomized 827 patients (1:1) 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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
PERCUTANEOUS coronary intervention; HEALTH outcome assessment; ACUTE coronary syndrome; CORONARY heart disease surgery; ENDOVASCULAR surgery; CARDIOVASCULAR system; COMPARATIVE studies; LONGITUDINAL method; RESEARCH methodology; MEDICAL care; MEDICAL cooperation; MYOCARDIAL infarction; PROBABILITY theory; RESEARCH; SURGICAL stents; TIME; TITANIUM; EVALUATION research; RANDOMIZED controlled trials; TREATMENT effectiveness; CORONARY angiography; CALCINOSIS; DISEASE complications
- Publication
Journal of Interventional Cardiology, 2017, Vol 30, Issue 2, p114
- ISSN
0896-4327
- Publication type
journal article
- DOI
10.1111/joic.12357