Relation between coronary calcium and major bleeding after percutaneous coronary intervention in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trials)

Philippe Genereux, Mahesh V. Madhavan, Gary S. Mintz, Akiko Maehara, Ajay J. Kirtane, Tullio Palmerini, Madhusudhan Tarigopula, Tom McAndrew, Alexandra J. Lansky, Roxana Mehran, Sorin J. Brener, Gregg W. Stone

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Percutaneous coronary intervention (PCI) of calcified coronary lesions has been associated with increased rates of adverse ischemic events. However, the potential association between the presence and severity of calcific deposits and bleeding complications has yet to be investigated. Data from 6,855 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) or ST-segment elevation myocardial infarction (STEMI) treated with PCI were pooled from 2 large-scale randomized controlled trials - Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction. Patients were stratified into 3 groups according the grade of target PCI lesion calcium (none to mild, moderate, and severe) as assessed by an independent angiographic core laboratory. Thirty-day bleeding event rates were assessed and compared among groups. In the total cohort undergoing PCI, none-to-mild target lesion calcium was found in 4,665 patients (68.1%), moderate target lesion calcium in 1,788 patients (26.1%), and severe target lesion calcium in 402 patients (5.9%). The 30-day rates of non-coronary artery bypass graft surgery major bleeding increased significantly with each degree of coronary calcium (none to mild = 5.9%, moderate = 7.2%, and severe = 11.2%, p = 0.0003). By multivariable analysis, presence of severe calcium was an independent predictor of non-coronary artery bypass graft major bleeding after PCI (hazard ratio 1.54, 95% confidence interval 1.09 to 2.17, p = 0.01). In conclusion, in patients undergoing PCI for non-ST-segment elevation acute coronary syndrome and ST-segment elevation myocardial infarction, target lesion coronary calcium was an independent predictor of major bleeding events. Further studies are needed to elucidate mechanisms underlying this finding and to optimize treatment of this high-risk population.

Original languageEnglish (US)
Pages (from-to)930-935
Number of pages6
JournalAmerican Journal of Cardiology
Volume113
Issue number6
DOIs
StatePublished - Mar 15 2014
Externally publishedYes

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Triage
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Catheterization
Stents
Myocardial Infarction
Hemorrhage
Calcium
Arteries
Transplants
Randomized Controlled Trials
Confidence Intervals
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Madhavan, Mahesh V. ; Mintz, Gary S. ; Maehara, Akiko ; Kirtane, Ajay J. ; Palmerini, Tullio ; Tarigopula, Madhusudhan ; McAndrew, Tom ; Lansky, Alexandra J. ; Mehran, Roxana ; Brener, Sorin J. ; Stone, Gregg W. / Relation between coronary calcium and major bleeding after percutaneous coronary intervention in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trials). In: American Journal of Cardiology. 2014 ; Vol. 113, No. 6. pp. 930-935.
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abstract = "Percutaneous coronary intervention (PCI) of calcified coronary lesions has been associated with increased rates of adverse ischemic events. However, the potential association between the presence and severity of calcific deposits and bleeding complications has yet to be investigated. Data from 6,855 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) or ST-segment elevation myocardial infarction (STEMI) treated with PCI were pooled from 2 large-scale randomized controlled trials - Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction. Patients were stratified into 3 groups according the grade of target PCI lesion calcium (none to mild, moderate, and severe) as assessed by an independent angiographic core laboratory. Thirty-day bleeding event rates were assessed and compared among groups. In the total cohort undergoing PCI, none-to-mild target lesion calcium was found in 4,665 patients (68.1{\%}), moderate target lesion calcium in 1,788 patients (26.1{\%}), and severe target lesion calcium in 402 patients (5.9{\%}). The 30-day rates of non-coronary artery bypass graft surgery major bleeding increased significantly with each degree of coronary calcium (none to mild = 5.9{\%}, moderate = 7.2{\%}, and severe = 11.2{\%}, p = 0.0003). By multivariable analysis, presence of severe calcium was an independent predictor of non-coronary artery bypass graft major bleeding after PCI (hazard ratio 1.54, 95{\%} confidence interval 1.09 to 2.17, p = 0.01). In conclusion, in patients undergoing PCI for non-ST-segment elevation acute coronary syndrome and ST-segment elevation myocardial infarction, target lesion coronary calcium was an independent predictor of major bleeding events. Further studies are needed to elucidate mechanisms underlying this finding and to optimize treatment of this high-risk population.",
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Relation between coronary calcium and major bleeding after percutaneous coronary intervention in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trials). / Genereux, Philippe; Madhavan, Mahesh V.; Mintz, Gary S.; Maehara, Akiko; Kirtane, Ajay J.; Palmerini, Tullio; Tarigopula, Madhusudhan; McAndrew, Tom; Lansky, Alexandra J.; Mehran, Roxana; Brener, Sorin J.; Stone, Gregg W.

In: American Journal of Cardiology, Vol. 113, No. 6, 15.03.2014, p. 930-935.

Research output: Contribution to journalArticle

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T1 - Relation between coronary calcium and major bleeding after percutaneous coronary intervention in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trials)

AU - Genereux, Philippe

AU - Madhavan, Mahesh V.

AU - Mintz, Gary S.

AU - Maehara, Akiko

AU - Kirtane, Ajay J.

AU - Palmerini, Tullio

AU - Tarigopula, Madhusudhan

AU - McAndrew, Tom

AU - Lansky, Alexandra J.

AU - Mehran, Roxana

AU - Brener, Sorin J.

AU - Stone, Gregg W.

PY - 2014/3/15

Y1 - 2014/3/15

N2 - Percutaneous coronary intervention (PCI) of calcified coronary lesions has been associated with increased rates of adverse ischemic events. However, the potential association between the presence and severity of calcific deposits and bleeding complications has yet to be investigated. Data from 6,855 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) or ST-segment elevation myocardial infarction (STEMI) treated with PCI were pooled from 2 large-scale randomized controlled trials - Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction. Patients were stratified into 3 groups according the grade of target PCI lesion calcium (none to mild, moderate, and severe) as assessed by an independent angiographic core laboratory. Thirty-day bleeding event rates were assessed and compared among groups. In the total cohort undergoing PCI, none-to-mild target lesion calcium was found in 4,665 patients (68.1%), moderate target lesion calcium in 1,788 patients (26.1%), and severe target lesion calcium in 402 patients (5.9%). The 30-day rates of non-coronary artery bypass graft surgery major bleeding increased significantly with each degree of coronary calcium (none to mild = 5.9%, moderate = 7.2%, and severe = 11.2%, p = 0.0003). By multivariable analysis, presence of severe calcium was an independent predictor of non-coronary artery bypass graft major bleeding after PCI (hazard ratio 1.54, 95% confidence interval 1.09 to 2.17, p = 0.01). In conclusion, in patients undergoing PCI for non-ST-segment elevation acute coronary syndrome and ST-segment elevation myocardial infarction, target lesion coronary calcium was an independent predictor of major bleeding events. Further studies are needed to elucidate mechanisms underlying this finding and to optimize treatment of this high-risk population.

AB - Percutaneous coronary intervention (PCI) of calcified coronary lesions has been associated with increased rates of adverse ischemic events. However, the potential association between the presence and severity of calcific deposits and bleeding complications has yet to be investigated. Data from 6,855 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) or ST-segment elevation myocardial infarction (STEMI) treated with PCI were pooled from 2 large-scale randomized controlled trials - Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction. Patients were stratified into 3 groups according the grade of target PCI lesion calcium (none to mild, moderate, and severe) as assessed by an independent angiographic core laboratory. Thirty-day bleeding event rates were assessed and compared among groups. In the total cohort undergoing PCI, none-to-mild target lesion calcium was found in 4,665 patients (68.1%), moderate target lesion calcium in 1,788 patients (26.1%), and severe target lesion calcium in 402 patients (5.9%). The 30-day rates of non-coronary artery bypass graft surgery major bleeding increased significantly with each degree of coronary calcium (none to mild = 5.9%, moderate = 7.2%, and severe = 11.2%, p = 0.0003). By multivariable analysis, presence of severe calcium was an independent predictor of non-coronary artery bypass graft major bleeding after PCI (hazard ratio 1.54, 95% confidence interval 1.09 to 2.17, p = 0.01). In conclusion, in patients undergoing PCI for non-ST-segment elevation acute coronary syndrome and ST-segment elevation myocardial infarction, target lesion coronary calcium was an independent predictor of major bleeding events. Further studies are needed to elucidate mechanisms underlying this finding and to optimize treatment of this high-risk population.

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