Généreux 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
Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada; Morristown Medical Center, Morristown, NJ, USA.
Cardiovascular Research Foundation, New York, NY, USA.
Int J Cardiol. 2017 Mar 15;231:61-67. doi: 10.1016/j.ijcard.2016.12.150. Epub 2016 Dec 26.
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).
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.
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 (p>0.05).
Contemporary DES PCI of calcified lesions is common and is associated with an increased risk of ischemic and bleeding complications.
对伴有冠状动脉钙化（CAC）的病变进行经皮冠状动脉介入治疗（PCI）很常见，且历来与不良事件风险增加相关。靶病变钙化（CAC）与预后之间的关联在不同代药物洗脱支架之间或高残余血小板反应性（PR）与低残余血小板反应性患者之间是否存在差异尚不清楚。我们评估了在接受当代药物洗脱支架（DES）PCI的患者中，CAC与不良缺血和出血事件之间的关联。
我们纳入了前瞻性ADAPT-DES研究中所有8582例成功接受DES PCI的患者。根据患者是否有CAC进行分组。我们使用多变量逻辑回归分析来确定CAC的独立预测因素。通过构建Kaplan-Meier曲线并拟合未调整和调整后的Cox比例风险模型，我们评估了2年主要不良心脏事件（MACE：死亡、心肌梗死或支架血栓形成）和出血的风险。我们通过在模型中纳入交互项来评估DES代和PR对CAC对预后影响的作用。
2644例（30.8%）患者存在CAC。年龄、吸烟、高血压、高脂血症、胰岛素治疗的糖尿病、血液透析和外周动脉疾病是CAC的独立预测因素。存在CAC与2年MACE和出血的未调整和调整后风险增加相关。CAC与缺血性预后之间的关联在各代DES和PR之间是一致的（p>0.05）。
当代对钙化病变进行DES PCI很常见，且与缺血和出血并发症风险增加相关。
