Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy

Peiren Shan, Gary S. Mintz, Bernhard Witzenbichler, D. Christopher Metzger, Michael J. Rinaldi, Peter L. Duffy, Giora Weisz, Thomas D. Stuckey, Bruce R. Brodie, Philippe Genereux, Aaron Crowley, Ajay J. Kirtane, Gregg W. Stone, Akiko Maehara

Research output: Contribution to journalArticle

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Abstract

Background Increasing coronary lesion calcification is thought to be associated with adverse percutaneous coronary intervention (PCI) and clinical outcomes. We investigated the effects of calcium burden on culprit lesion morphology and clinical events after intravascular ultrasound (IVUS)-guided PCI in the ADAPT-DES study. Methods ADAPT-DES was a prospective, multicenter registry of 8582 consecutive patients undergoing successful PCI using DES. A pre-specified virtual histology (VH)-IVUS substudy of 638 culprit lesions (638 patients) had both pre- and post-PCI VH-IVUS. We divided lesions into tertiles according to pre-PCI percent dense calcium volume (DCV% = dense calcium/plaque volume × 100). Results Compared with low and intermediate DCV% tertiles, patients in the high DCV% tertile had the largest arc of superficial calcium, highest percentage of necrotic core volume, and smallest remodeling index; they were also more likely to have advanced lesion morphology such as attenuated plaque and VH thin-cap fibroatheromas. In the high DCV% tertile IVUS guidance was associated with a minimum stent area that was smaller than tertiles with less calcium (p = 0.01), but acceptable range, and similar stent expansion (73.8 ± 16.8% vs. 74.0 ± 19.2% vs. 72.4 ± 17.3%, p = 0.62) after more frequent use of rotational atherectomy and higher maximum inflation pressure. There was no significant association between pre-PCI DCV% and 2-year target lesion revascularization or major adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis). Conclusions Increasing coronary artery calcification burden was associated with more advanced, complex VH-IVUS lesion morphology, but not with adverse clinical outcomes, perhaps due to more aggressive PCI techniques that optimized stent expansion.

Original languageEnglish (US)
Pages (from-to)97-102
Number of pages6
JournalInternational Journal of Cardiology
Volume248
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

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Percutaneous Coronary Intervention
Calcium
Stents
Histology
Coronary Atherectomy
Economic Inflation
Registries
Coronary Vessels
Thrombosis
Myocardial Infarction
Pressure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Shan, P., Mintz, G. S., Witzenbichler, B., Metzger, D. C., Rinaldi, M. J., Duffy, P. L., ... Maehara, A. (2017). Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy. International Journal of Cardiology, 248, 97-102. https://doi.org/10.1016/j.ijcard.2017.08.028
Shan, Peiren ; Mintz, Gary S. ; Witzenbichler, Bernhard ; Metzger, D. Christopher ; Rinaldi, Michael J. ; Duffy, Peter L. ; Weisz, Giora ; Stuckey, Thomas D. ; Brodie, Bruce R. ; Genereux, Philippe ; Crowley, Aaron ; Kirtane, Ajay J. ; Stone, Gregg W. ; Maehara, Akiko. / Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy. In: International Journal of Cardiology. 2017 ; Vol. 248. pp. 97-102.
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abstract = "Background Increasing coronary lesion calcification is thought to be associated with adverse percutaneous coronary intervention (PCI) and clinical outcomes. We investigated the effects of calcium burden on culprit lesion morphology and clinical events after intravascular ultrasound (IVUS)-guided PCI in the ADAPT-DES study. Methods ADAPT-DES was a prospective, multicenter registry of 8582 consecutive patients undergoing successful PCI using DES. A pre-specified virtual histology (VH)-IVUS substudy of 638 culprit lesions (638 patients) had both pre- and post-PCI VH-IVUS. We divided lesions into tertiles according to pre-PCI percent dense calcium volume (DCV{\%} = dense calcium/plaque volume × 100). Results Compared with low and intermediate DCV{\%} tertiles, patients in the high DCV{\%} tertile had the largest arc of superficial calcium, highest percentage of necrotic core volume, and smallest remodeling index; they were also more likely to have advanced lesion morphology such as attenuated plaque and VH thin-cap fibroatheromas. In the high DCV{\%} tertile IVUS guidance was associated with a minimum stent area that was smaller than tertiles with less calcium (p = 0.01), but acceptable range, and similar stent expansion (73.8 ± 16.8{\%} vs. 74.0 ± 19.2{\%} vs. 72.4 ± 17.3{\%}, p = 0.62) after more frequent use of rotational atherectomy and higher maximum inflation pressure. There was no significant association between pre-PCI DCV{\%} and 2-year target lesion revascularization or major adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis). Conclusions Increasing coronary artery calcification burden was associated with more advanced, complex VH-IVUS lesion morphology, but not with adverse clinical outcomes, perhaps due to more aggressive PCI techniques that optimized stent expansion.",
author = "Peiren Shan and Mintz, {Gary S.} and Bernhard Witzenbichler and Metzger, {D. Christopher} and Rinaldi, {Michael J.} and Duffy, {Peter L.} and Giora Weisz and Stuckey, {Thomas D.} and Brodie, {Bruce R.} and Philippe Genereux and Aaron Crowley and Kirtane, {Ajay J.} and Stone, {Gregg W.} and Akiko Maehara",
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Shan, P, Mintz, GS, Witzenbichler, B, Metzger, DC, Rinaldi, MJ, Duffy, PL, Weisz, G, Stuckey, TD, Brodie, BR, Genereux, P, Crowley, A, Kirtane, AJ, Stone, GW & Maehara, A 2017, 'Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy', International Journal of Cardiology, vol. 248, pp. 97-102. https://doi.org/10.1016/j.ijcard.2017.08.028

Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy. / Shan, Peiren; Mintz, Gary S.; Witzenbichler, Bernhard; Metzger, D. Christopher; Rinaldi, Michael J.; Duffy, Peter L.; Weisz, Giora; Stuckey, Thomas D.; Brodie, Bruce R.; Genereux, Philippe; Crowley, Aaron; Kirtane, Ajay J.; Stone, Gregg W.; Maehara, Akiko.

In: International Journal of Cardiology, Vol. 248, 01.12.2017, p. 97-102.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy

AU - Shan, Peiren

AU - Mintz, Gary S.

AU - Witzenbichler, Bernhard

AU - Metzger, D. Christopher

AU - Rinaldi, Michael J.

AU - Duffy, Peter L.

AU - Weisz, Giora

AU - Stuckey, Thomas D.

AU - Brodie, Bruce R.

AU - Genereux, Philippe

AU - Crowley, Aaron

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

AU - Maehara, Akiko

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background Increasing coronary lesion calcification is thought to be associated with adverse percutaneous coronary intervention (PCI) and clinical outcomes. We investigated the effects of calcium burden on culprit lesion morphology and clinical events after intravascular ultrasound (IVUS)-guided PCI in the ADAPT-DES study. Methods ADAPT-DES was a prospective, multicenter registry of 8582 consecutive patients undergoing successful PCI using DES. A pre-specified virtual histology (VH)-IVUS substudy of 638 culprit lesions (638 patients) had both pre- and post-PCI VH-IVUS. We divided lesions into tertiles according to pre-PCI percent dense calcium volume (DCV% = dense calcium/plaque volume × 100). Results Compared with low and intermediate DCV% tertiles, patients in the high DCV% tertile had the largest arc of superficial calcium, highest percentage of necrotic core volume, and smallest remodeling index; they were also more likely to have advanced lesion morphology such as attenuated plaque and VH thin-cap fibroatheromas. In the high DCV% tertile IVUS guidance was associated with a minimum stent area that was smaller than tertiles with less calcium (p = 0.01), but acceptable range, and similar stent expansion (73.8 ± 16.8% vs. 74.0 ± 19.2% vs. 72.4 ± 17.3%, p = 0.62) after more frequent use of rotational atherectomy and higher maximum inflation pressure. There was no significant association between pre-PCI DCV% and 2-year target lesion revascularization or major adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis). Conclusions Increasing coronary artery calcification burden was associated with more advanced, complex VH-IVUS lesion morphology, but not with adverse clinical outcomes, perhaps due to more aggressive PCI techniques that optimized stent expansion.

AB - Background Increasing coronary lesion calcification is thought to be associated with adverse percutaneous coronary intervention (PCI) and clinical outcomes. We investigated the effects of calcium burden on culprit lesion morphology and clinical events after intravascular ultrasound (IVUS)-guided PCI in the ADAPT-DES study. Methods ADAPT-DES was a prospective, multicenter registry of 8582 consecutive patients undergoing successful PCI using DES. A pre-specified virtual histology (VH)-IVUS substudy of 638 culprit lesions (638 patients) had both pre- and post-PCI VH-IVUS. We divided lesions into tertiles according to pre-PCI percent dense calcium volume (DCV% = dense calcium/plaque volume × 100). Results Compared with low and intermediate DCV% tertiles, patients in the high DCV% tertile had the largest arc of superficial calcium, highest percentage of necrotic core volume, and smallest remodeling index; they were also more likely to have advanced lesion morphology such as attenuated plaque and VH thin-cap fibroatheromas. In the high DCV% tertile IVUS guidance was associated with a minimum stent area that was smaller than tertiles with less calcium (p = 0.01), but acceptable range, and similar stent expansion (73.8 ± 16.8% vs. 74.0 ± 19.2% vs. 72.4 ± 17.3%, p = 0.62) after more frequent use of rotational atherectomy and higher maximum inflation pressure. There was no significant association between pre-PCI DCV% and 2-year target lesion revascularization or major adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis). Conclusions Increasing coronary artery calcification burden was associated with more advanced, complex VH-IVUS lesion morphology, but not with adverse clinical outcomes, perhaps due to more aggressive PCI techniques that optimized stent expansion.

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U2 - 10.1016/j.ijcard.2017.08.028

DO - 10.1016/j.ijcard.2017.08.028

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AN - SCOPUS:85029633612

VL - 248

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JO - International Journal of Cardiology

JF - International Journal of Cardiology

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