Bourantas Christos V, Zhang Yao-Jun, Garg Scot, Iqbal Javaid, Valgimigli Marco, Windecker Stephan, Mohr Friedrich W, Silber Sigmund, Vries Ton de, Onuma Yoshinobu, Garcia-Garcia Hector M, Morel Marie-Angele, Serruys Patrick W
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Cardiology, East Lancashire NHS Trust Blackburn, Lancashire, UK.
Heart. 2014 Aug;100(15):1158-64. doi: 10.1136/heartjnl-2013-305180. Epub 2014 May 20.
To investigate the long-term prognostic implications of coronary calcification in patients undergoing percutaneous coronary intervention for obstructive coronary artery disease.
Patient-level data from 6296 patients enrolled in seven clinical drug-eluting stents trials were analysed to identify in angiographic images the presence of severe coronary calcification by an independent academic research organisation (Cardialysis, Rotterdam, The Netherlands). Clinical outcomes at 3-years follow-up including all-cause mortality, death-myocardial infarction (MI), and the composite end-point of all-cause death-MI-any revascularisation were compared between patients with and without severe calcification.
Severe calcification was detected in 20% of the studied population. Patients with severe lesion calcification were less likely to have undergone complete revascularisation (48% vs 55.6%, p<0.001) and had an increased mortality compared with those without severely calcified arteries (10.8% vs 4.4%, p<0.001). The event rate was also high in patients with severely calcified lesions for the combined end-point death-MI (22.9% vs 10.9%; p<0.001) and death-MI- any revascularisation (31.8% vs 22.4%; p<0.001). On multivariate Cox regression analysis, including the Syntax score, the presence of severe coronary calcification was an independent predictor of poor prognosis (HR: 1.33 95% CI 1.00 to 1.77, p=0.047 for death; 1.23, 95% CI 1.02 to 1.49, p=0.031 for death-MI, and 1.18, 95% CI 1.01 to 1.39, p=0.042 for death-MI- any revascularisation), but it was not associated with an increased risk of stent thrombosis.
Patients with severely calcified lesions have worse clinical outcomes compared to those without severe coronary calcification. Severe coronary calcification appears as an independent predictor of worse prognosis, and should be considered as a marker of advanced atherosclerosis.
探讨冠状动脉钙化对接受经皮冠状动脉介入治疗的阻塞性冠状动脉疾病患者的长期预后影响。
分析了来自七项临床药物洗脱支架试验的6296例患者的个体水平数据，由一个独立的学术研究机构（荷兰鹿特丹的Cardialysis）在血管造影图像中识别严重冠状动脉钙化的存在情况。比较了有和没有严重钙化的患者在3年随访时的临床结局，包括全因死亡率、死亡-心肌梗死（MI）以及全因死亡-MI-任何血管重建的复合终点。
在20%的研究人群中检测到严重钙化。与没有严重动脉钙化的患者相比，严重病变钙化的患者完全血管重建的可能性较小（48%对55.6%，p<0.001），且死亡率增加（10.8%对4.4%，p<0.001）。对于死亡-MI复合终点（22.9%对10.9%；p<0.001）和死亡-MI-任何血管重建（31.8%对22.4%；p<0.001），严重钙化病变患者的事件发生率也很高。在多变量Cox回归分析中，包括Syntax评分，严重冠状动脉钙化的存在是预后不良的独立预测因素（全因死亡的HR：1.33，95%CI 1.00至1.77，p=0.047；死亡-MI的HR：1.23，95%CI 1.02至1.49，p=0.031；死亡-MI-任何血管重建的HR：1.18，95%CI 1.01至1.39，p=0.042），但它与支架血栓形成风险增加无关。
与没有严重冠状动脉钙化的患者相比，严重钙化病变的患者临床结局更差。严重冠状动脉钙化似乎是预后更差的独立预测因素，应被视为晚期动脉粥样硬化的标志物。
