What is the Frequency and Impact of Coronary Calcification in PCI for ACS?

Moderate to severe lesion calcification is frequent in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) and ST-segment elevation myocardial infarction (STEMI), and "is strongly predictive of stent thrombosis and ischemic target lesion revascularization at one year," according to a study published Feb. 19 in the Journal of the American College of Cardiology.

Since little is known about the impact of coronary calcification on outcomes after percutaneous coronary intervention (PCI) for patients with NSTEACS and STEMI, and no studies have evaluated the frequency and impact of coronary calcification in these patients, the authors pooled 6,855 patients with ACS who underwent a PCI procedure from the ACUITY and HORIZONS-AMI trials.

Additional Resources
  • Trial Summary ACUITY
  • Trial Summary HORIZONS-AMI
  • Results showed target lesion calcification was severe in 402 patients, moderate in 1788 patients, and mild or not present in 4,665 of patients. Further, "the unadjusted 1-year rates of death, cardiac death, definite stent thrombosis, and ischemic target lesion and vessel revascularization were significantly increased in patients with moderate to severe target lesion calcification. By multivariable analysis, the presence of moderate to severe target lesion calcification was an independent predictor of 1-year definite stent thrombosis (HR [95 percent CI] =1.62 [1.14, 2.30], p=0.007) and ischemic target lesion revascularization (HR [95 percent CI] = 1.44 [1.17, 1.78], p=0.0007)."

    The authors add that their results showed that "target lesions in NSTEACS and STEMI were frequently calcified, as assessed by an angiographic core library; PCI in patients with moderately and severely calcified target lesions compared to those with no or mild calcification was associated with suboptimal angiographic results and procedural complications; and PCI of calcified lesions was independently predictive of adverse ischemic outcomes including definite stent thrombosis and unplanned ischemia-driven repeat revascularization within one year post-PCI, as compared to patients in whom all target lesions had no or only mild calcification."

    Moving forward, "novel approaches are urgently needed to improve outcomes of high-risk ACS patients with calcified lesions undergoing PCI," the authors conclude.

    Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

    Keywords: Myocardial Infarction, Acute Coronary Syndrome, Thrombosis, Stents, Percutaneous Coronary Intervention

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