Author + information
- Philippe Genereux1,
- Bjorn Redfors2,
- Gregg Stone3,
- Philippe Gabriel Steg4,
- C. Michael Gibson5,
- Christian Hamm6,
- Matthew Price7,
- Jayne Prats8,
- Harvey White9 and
- Deepak Bhatt10
- 1Columbia, New York, New York, United States
- 2Cardiovascular Research Foundation, New York, New York, United States
- 3Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 4Groupe Hospitalier Bichat – Claude-Bernard, Paris, France
- 5Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- 6Kerckhoff Clinic, Bad Nauheim, Germany
- 7Scripps Clinic, La Jolla, California, United States
- 8Elysis, Carlisle, Massachusetts, United States
- 9Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
- 10Brigham and Women's Hospital, Boston, Massachusetts, United States
Percutaneous coronary intervention (PCI) of calcified lesions has been associated with an increased risk of adverse ischemic events. The importance of coronary artery calcification (CAC) severity and its association with outcomes has not been clearly studied in a large, contemporary cohort. We sought to assess the relationship between the severity of CAC and clinical outcomes after PCI from a large contemporary study with coronary calcification defined by an independent angiographic core laboratory.
Patient outcomes in the Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PHOENIX; randomization to periprocedural cangrelor vs clopidogrel) trial were compared according to CAC severity, classified as severe, moderate, or mild/none by the core lab. The primary efficacy endpoint was the 48-hour rate of major adverse cardiac events (MACE), defined as the adjudicated composite of death, myocardial infarction, stent thrombosis, or ischemia-driven revascularization; 30-day outcomes were also examined.
Among 10,749 patients undergoing PCI and having core lab data, 581 (5.4%) had severe CAC, 2151 (20.0%) had moderate CAC, and 8017 (74.6%) had none/mild CAC. Patient characteristics associated with severe CAC were female sex, diabetes, peripheral artery disease, heart failure, prior coronary artery bypass grafting, multivessel disease, and low body weight. Patients with severe CAC had higher 48-hour and 30-day rates of MACE and MI. No interaction was detected between CAC and treatment assignment (cangrelor vs clopidogrel) in regard to reduction in MACE (pinteraction=0.43).
|48-Hour Clinical Outcomes||None/Mild CAC n=8014||Moderate CAC N=2151||Severe CAC N=581||p-value*|
|MACE||411/8014 (5.1%)||117/2151 (5.4%)||47/581 (8.1%)||0.002|
|Death||25/8014 (0.3%)||8/2151 (0.4%)||3/581 (0.5%)||0.40|
|Myocardial infarction||326/8014 (4.1%)||98/2151 (4.6%)||35/581 (6.0%)||0.02|
|ID-revascularization||48/8014 (0.6%)||7/2151 (0.3%)||9/581 (1.5%)||0.006|
|Stent thrombosis||88/8014 (1.1%)||22/2151 (1.0%)||9/581 (1.5%)||0.32|
|IPST||66/8014 (0.8%)||18/2151 (0.8%)||5/581 (0.9%)||0.92|
*Severe vs none/mild. ID = ischemia-driven.
Severe CAC was associated with increased risk of ischemic complications, though the benefit of cangrelor was consistent in these patients. Better interventional strategies are needed for patients with severe calcification.
CORONARY: PCI Outcomes