Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents

Philippe Genereux, Björn Redfors, Bernhard Witzenbichler, Marie Pier Arsenault, Giora Weisz, Thomas D. Stuckey, Michael J. Rinaldi, Franz Josef Neumann, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Ernest L. Mazzaferri, Dominic P. Francese, Guillaume Marquis-Gravel, Gary S. Mintz, Ajay J. Kirtane, Akiko Maehara, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

Background Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is common and has been historically associated with an increased risk of adverse events. Whether the association between target lesion calcification (CAC) and outcomes differ across drug-eluting stent generation or between patients with high vs. low residual platelet reactivity (PR) remains unknown. We assessed the association of CAC with adverse ischemic and bleeding events among patients undergoing contemporary PCI with drug-eluting stents (DES). Methods We included all 8582 patients who underwent successful PCI with DES in the prospective ADAPT-DES study. Patients were grouped according to whether or not they had CAC. We used a multivariable logistic regression analysis to determine independent predictors of CAC. We assessed the 2-year risk of major adverse cardiac events (MACE: Death, myocardial infarction, or stent thrombosis) and bleeding by constructing Kaplan-Meier curves and fitting unadjusted and adjusted Cox proportional hazards models. We assessed the influence of DES generation and PR on the effect of CAC on outcomes by including interaction terms in the models. Results CAC was present in 2644 (30.8%) patients. Age, smoking, hypertension, hyperlipidemia, insulin-treated diabetes, hemodialysis, and peripheral artery disease were independent predictors of CAC. Having a CAC was associated with increased unadjusted and adjusted hazards for 2-year MACE and bleeding. The association between CAC and ischemic outcomes was consistent across DES generations and PR (pinteraction > 0.05). Conclusion Contemporary DES PCI of calcified lesions is common and is associated with an increased risk of ischemic and bleeding complications.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalInternational Journal of Cardiology
Volume231
DOIs
StatePublished - Mar 15 2017
Externally publishedYes

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Drug-Eluting Stents
Percutaneous Coronary Intervention
Hemorrhage
Blood Platelets
Peripheral Arterial Disease
Hyperlipidemias
Proportional Hazards Models
Stents
Renal Dialysis
Thrombosis
Logistic Models
Smoking
Myocardial Infarction
Regression Analysis
Insulin
Hypertension

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Redfors, Björn ; Witzenbichler, Bernhard ; Arsenault, Marie Pier ; Weisz, Giora ; Stuckey, Thomas D. ; Rinaldi, Michael J. ; Neumann, Franz Josef ; Christopher Metzger, D. ; Henry, Timothy D. ; Cox, David A. ; Duffy, Peter L. ; Mazzaferri, Ernest L. ; Francese, Dominic P. ; Marquis-Gravel, Guillaume ; Mintz, Gary S. ; Kirtane, Ajay J. ; Maehara, Akiko ; Mehran, Roxana ; Stone, Gregg W. / Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents. In: International Journal of Cardiology. 2017 ; Vol. 231. pp. 61-67.
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title = "Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents",
abstract = "Background Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is common and has been historically associated with an increased risk of adverse events. Whether the association between target lesion calcification (CAC) and outcomes differ across drug-eluting stent generation or between patients with high vs. low residual platelet reactivity (PR) remains unknown. We assessed the association of CAC with adverse ischemic and bleeding events among patients undergoing contemporary PCI with drug-eluting stents (DES). Methods We included all 8582 patients who underwent successful PCI with DES in the prospective ADAPT-DES study. Patients were grouped according to whether or not they had CAC. We used a multivariable logistic regression analysis to determine independent predictors of CAC. We assessed the 2-year risk of major adverse cardiac events (MACE: Death, myocardial infarction, or stent thrombosis) and bleeding by constructing Kaplan-Meier curves and fitting unadjusted and adjusted Cox proportional hazards models. We assessed the influence of DES generation and PR on the effect of CAC on outcomes by including interaction terms in the models. Results CAC was present in 2644 (30.8{\%}) patients. Age, smoking, hypertension, hyperlipidemia, insulin-treated diabetes, hemodialysis, and peripheral artery disease were independent predictors of CAC. Having a CAC was associated with increased unadjusted and adjusted hazards for 2-year MACE and bleeding. The association between CAC and ischemic outcomes was consistent across DES generations and PR (pinteraction > 0.05). Conclusion Contemporary DES PCI of calcified lesions is common and is associated with an increased risk of ischemic and bleeding complications.",
author = "Philippe Genereux and Bj{\"o}rn Redfors and Bernhard Witzenbichler and Arsenault, {Marie Pier} and Giora Weisz and Stuckey, {Thomas D.} and Rinaldi, {Michael J.} and Neumann, {Franz Josef} and {Christopher Metzger}, D. and Henry, {Timothy D.} and Cox, {David A.} and Duffy, {Peter L.} and Mazzaferri, {Ernest L.} and Francese, {Dominic P.} and Guillaume Marquis-Gravel and Mintz, {Gary S.} and Kirtane, {Ajay J.} and Akiko Maehara and Roxana Mehran and Stone, {Gregg W.}",
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Genereux, P, Redfors, B, Witzenbichler, B, Arsenault, MP, Weisz, G, Stuckey, TD, Rinaldi, MJ, Neumann, FJ, Christopher Metzger, D, Henry, TD, Cox, DA, Duffy, PL, Mazzaferri, EL, Francese, DP, Marquis-Gravel, G, Mintz, GS, Kirtane, AJ, Maehara, A, Mehran, R & Stone, GW 2017, 'Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents', International Journal of Cardiology, vol. 231, pp. 61-67. https://doi.org/10.1016/j.ijcard.2016.12.150

Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents. / Genereux, Philippe; Redfors, Björn; Witzenbichler, Bernhard; Arsenault, Marie Pier; Weisz, Giora; Stuckey, Thomas D.; Rinaldi, Michael J.; Neumann, Franz Josef; Christopher Metzger, D.; Henry, Timothy D.; Cox, David A.; Duffy, Peter L.; Mazzaferri, Ernest L.; Francese, Dominic P.; Marquis-Gravel, Guillaume; Mintz, Gary S.; Kirtane, Ajay J.; Maehara, Akiko; Mehran, Roxana; Stone, Gregg W.

In: International Journal of Cardiology, Vol. 231, 15.03.2017, p. 61-67.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents

AU - Genereux, Philippe

AU - Redfors, Björn

AU - Witzenbichler, Bernhard

AU - Arsenault, Marie Pier

AU - Weisz, Giora

AU - Stuckey, Thomas D.

AU - Rinaldi, Michael J.

AU - Neumann, Franz Josef

AU - Christopher Metzger, D.

AU - Henry, Timothy D.

AU - Cox, David A.

AU - Duffy, Peter L.

AU - Mazzaferri, Ernest L.

AU - Francese, Dominic P.

AU - Marquis-Gravel, Guillaume

AU - Mintz, Gary S.

AU - Kirtane, Ajay J.

AU - Maehara, Akiko

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2017/3/15

Y1 - 2017/3/15

N2 - Background Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is common and has been historically associated with an increased risk of adverse events. Whether the association between target lesion calcification (CAC) and outcomes differ across drug-eluting stent generation or between patients with high vs. low residual platelet reactivity (PR) remains unknown. We assessed the association of CAC with adverse ischemic and bleeding events among patients undergoing contemporary PCI with drug-eluting stents (DES). Methods We included all 8582 patients who underwent successful PCI with DES in the prospective ADAPT-DES study. Patients were grouped according to whether or not they had CAC. We used a multivariable logistic regression analysis to determine independent predictors of CAC. We assessed the 2-year risk of major adverse cardiac events (MACE: Death, myocardial infarction, or stent thrombosis) and bleeding by constructing Kaplan-Meier curves and fitting unadjusted and adjusted Cox proportional hazards models. We assessed the influence of DES generation and PR on the effect of CAC on outcomes by including interaction terms in the models. Results CAC was present in 2644 (30.8%) patients. Age, smoking, hypertension, hyperlipidemia, insulin-treated diabetes, hemodialysis, and peripheral artery disease were independent predictors of CAC. Having a CAC was associated with increased unadjusted and adjusted hazards for 2-year MACE and bleeding. The association between CAC and ischemic outcomes was consistent across DES generations and PR (pinteraction > 0.05). Conclusion Contemporary DES PCI of calcified lesions is common and is associated with an increased risk of ischemic and bleeding complications.

AB - Background Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is common and has been historically associated with an increased risk of adverse events. Whether the association between target lesion calcification (CAC) and outcomes differ across drug-eluting stent generation or between patients with high vs. low residual platelet reactivity (PR) remains unknown. We assessed the association of CAC with adverse ischemic and bleeding events among patients undergoing contemporary PCI with drug-eluting stents (DES). Methods We included all 8582 patients who underwent successful PCI with DES in the prospective ADAPT-DES study. Patients were grouped according to whether or not they had CAC. We used a multivariable logistic regression analysis to determine independent predictors of CAC. We assessed the 2-year risk of major adverse cardiac events (MACE: Death, myocardial infarction, or stent thrombosis) and bleeding by constructing Kaplan-Meier curves and fitting unadjusted and adjusted Cox proportional hazards models. We assessed the influence of DES generation and PR on the effect of CAC on outcomes by including interaction terms in the models. Results CAC was present in 2644 (30.8%) patients. Age, smoking, hypertension, hyperlipidemia, insulin-treated diabetes, hemodialysis, and peripheral artery disease were independent predictors of CAC. Having a CAC was associated with increased unadjusted and adjusted hazards for 2-year MACE and bleeding. The association between CAC and ischemic outcomes was consistent across DES generations and PR (pinteraction > 0.05). Conclusion Contemporary DES PCI of calcified lesions is common and is associated with an increased risk of ischemic and bleeding complications.

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U2 - 10.1016/j.ijcard.2016.12.150

DO - 10.1016/j.ijcard.2016.12.150

M3 - Article

VL - 231

SP - 61

EP - 67

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -