Coronary Artery Calcifications in Women Undergoing PCI

Study Questions:

Does coronary artery calcium (CAC) provide prognostic value among women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES)?

Methods:

Data from 26 randomized trials were pooled as part of the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration. Patient-level data were excluded if women were randomized to a bare-metal stent, if a trial had excluded participants with moderate or severe CAC, and if women had missing information on CAC for the target lesion. The study population was grouped according to the presence of moderate or severe versus mild or no target lesion CAC, assessed through coronary angiography. The primary endpoints of interest were the composite of death, myocardial infarction (MI), or target lesion revascularization and death, MI, or stent thrombosis at 3-year follow-up.

Results:

A total of 11,557 women were included in the data set, of which CAC status was available in 6,371 women. Of the women with CAC information, 25.5% (n = 1,622) had moderate to severe CAC. Women with CAC were more likely to have a stable coronary artery disease presentation and were more likely to have multivessel disease compared with women without moderate to severe CAC. In fully adjusted models, independent correlates of CAC were age, hypertension, hypercholesterolemia, smoking, previous coronary artery bypass graft surgery, and worse left ventricular and renal function. At 3 years, women with CAC were at higher risk for death, MI, or target lesion revascularization (18.2% vs. 13.1%; adjusted hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.33-1.84; p < 0.0001) and death, MI, or stent thrombosis (12.7% vs. 8.6%; adjusted HR, 1.48; 95% CI, 1.21-1.80; p = 0.0001). The adverse effect of CAC on ischemic outcomes appeared to be consistent across clinical and angiographic subsets of women, including new-generation DES.

Conclusions:

The investigators concluded that women undergoing PCI of calcified lesions tend to have a worse clinical profile and remain at increased ischemic risk, irrespective of new-generation DES.

Perspective:

These data suggest that CAC provides prognostic information on women who are undergoing PCI with DES interventions.

Clinical Topics: Cardiac Surgery, Clinical Topic Collection: Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Homozygous Familial Hypercholesterolemia, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging, Hypertension, Smoking

Keywords: Coronary Angiography, Coronary Artery Bypass, Coronary Artery Disease, Drug-Eluting Stents, Hypercholesterolemia, Hypertension, Ischemia, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Primary Prevention, Risk, Smoking, Stents, Thrombosis, Vascular Calcification, Women


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