Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences.
Circ J. 2020 Dec 25;85(1):50-58. doi: 10.1253/circj.CJ-20-0761. Epub 2020 Dec 9.
Moderate/severe coronary artery calcification (CAC) predicts worse clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). However, to date most studies have been modest in size and with limited follow-up. We aimed to assess the association between calcification severity and long-term clinical outcomes in a large cohort undergoing PCI.
In total, 10,068 consecutive patients who underwent PCI at Fuwai Hospital were enrolled in this prospective observational study. Patients were categorized as none/mild or moderate/severe CAC according to the severity of the target lesion by visual assessment of coronary angiography. Major adverse cardiovascular events (MACE), a composite event of death, myocardial infarction and revascularization, at 5 years were assessed. None/mild CAC was observed in 8,229 (81.7%) patients, and moderate/severe CAC was observed in 1,839 (18.3%) patients. Patients with moderate/severe CAC had a significantly higher rate of 5-year unplanned revascularization (15.2% vs. 13.2%, P=0.022) and MACE (20.7% vs. 17.9%, P=0.005). After propensity score matching, the moderate/severe CAC group still had a higher rate of 5-year unplanned revascularization (15.2% vs. 12.6%, P=0.019). Cox regression analysis using clinically significant variables revealed moderate/severe calcification was independently associated with higher risk of 2-year unplanned target vessel revascularization (hazard ratio (HR)=1.287, 95% confidence interval (CI): 1.036-1.600, P=0.023) and MACE (HR=1.242, 95% CI: 1.039-1.484, P=0.017), but not 5-year unplanned revascularization and MACE.
In patients undergoing PCI, moderate/severe coronary calcification increases the risk of long-term MACE.
中度/重度冠状动脉钙化（CAC）可预测接受经皮冠状动脉介入治疗（PCI）的患者的临床结局较差。然而，迄今为止，大多数研究规模较小，随访时间有限。我们旨在评估在接受 PCI 的大型队列中钙化严重程度与长期临床结局之间的关系。
共有 10068 例连续接受阜外医院 PCI 的患者纳入本前瞻性观察研究。根据冠状动脉造影的靶病变严重程度的目测，患者分为无/轻度或中度/重度 CAC。评估 5 年时的主要不良心血管事件（MACE），即死亡、心肌梗死和血运重建的复合事件。8229 例（81.7%）患者无/轻度 CAC，1839 例（18.3%）患者中度/重度 CAC。中度/重度 CAC 患者 5 年未计划血运重建的发生率（15.2% vs. 13.2%，P=0.022）和 MACE 发生率（20.7% vs. 17.9%，P=0.005）显著更高。经过倾向评分匹配后，中/重度 CAC 组 5 年未计划血运重建的发生率仍较高（15.2% vs. 12.6%，P=0.019）。使用临床显著变量的 Cox 回归分析显示，中度/重度钙化与 2 年未计划靶血管血运重建的风险增加独立相关（危险比（HR）=1.287，95%置信区间（CI）：1.036-1.600，P=0.023）和 MACE（HR=1.242，95% CI：1.039-1.484，P=0.017），但与 5 年未计划血运重建和 MACE 无关。
在接受 PCI 的患者中，中度/重度冠状动脉钙化增加了长期发生 MACE 的风险。
