Mattesini Alessio, Di Mario Carlo
Structural Interventional Cardiology Unit, Careggi University Hospital, Florence, Italy.
Structural Interventional Cardiology Unit, Careggi University Hospital, Florence, Italy.
Int J Cardiol. 2017 Mar 15;231:97-98. doi: 10.1016/j.ijcard.2017.01.054. Epub 2017 Jan 10.
In this substudy of the ADAPT-DES trial Généreux et al. compared two years outcomes according to the presence or absence of coronary artery calcification (CAC) as assessed by coronary angiography. Coronary calcification was an independent predictor of interventional treatment failure and a higher incidence of both ischemic events and bleeding. The cohort with CAC was older with a higher prevalence of risk factors and comorbidities and an increased anatomical complexity of the target lesions, explaining only in part the worse outcome of the CAC population that persisted at multivariate analysis. Incomplete expansion and poor stent apposition, more frequent in calcified lesions, are predictive of target lesion failure and late stent thrombosis. The main limitation of the study is the use of angiography for CAC assessment with a likely major underestimation of CAC burden. Intravascular imaging might also help for a more accurate quantification of the CAC burden and characteristics, selecting the lesions in need of a calcium modification with atherectomy or lithotripsy before stent implantation.
在ADAPT-DES试验的这项子研究中，热内鲁等人根据冠状动脉造影评估的冠状动脉钙化（CAC）的有无比较了两年的结果。冠状动脉钙化是介入治疗失败以及缺血事件和出血发生率较高的独立预测因素。患有CAC的队列年龄更大，危险因素和合并症的患病率更高，靶病变的解剖复杂性增加，这仅部分解释了在多变量分析中持续存在的CAC人群较差的结果。钙化病变中更常见的不完全扩张和支架贴壁不良可预测靶病变失败和晚期支架血栓形成。该研究的主要局限性在于使用血管造影评估CAC，可能会严重低估CAC负荷。血管内成像也可能有助于更准确地量化CAC负荷和特征，在支架植入前选择需要通过旋切术或碎石术进行钙化修饰的病变。
