Calcification may lead to poor prognosis after NSTEACS and STEMI

Moderate or severe coronary calcification is common in patients with non-ST elevated acute coronary syndrome (NSTEACS) and STEMI, according to a study published online Feb. 19 in the Journal of the American College of Cardiology. The study also found the degree of calcification predictive of stent thrombosis and ischemic target lesion revascularization (TLR).

Researchers led by Philippe Genereux, MD, of NewYork-Presbyterian Hospital and Columbia University Medical Center in New York, pooled data from 6,855 patients with ACS who underwent PCI who participated in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) and the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. ACUITY evaluated a strategy of heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin plus a GPI or bivalirudin alone in patients prior to coronary angiography with NSTEACS. After angiography, patients underwent either PCI, CABG or medical therapy. The HORIZONS-AMI trial compared heparin plus GPI with bivalirudin alone in patients with STEMI. Patients underwent angiography followed by PCI, CABG or medical therapy.

They stratified patients based on the severity of PCI target lesion calcification, classified as none/mild, moderate or severe. An independent angiographic core laboratory assessed severity. They also evaluated major adverse cardiovascular events, defined as the composite of death, reinfarction and unplanned ischemic revascularization.

Of the 6,855 patients, 402 had severe target lesion calcification, 1,788 had moderate and 4,665 had none/mild. Moderate/severe calcification was more common in older patients, men, patients with hypertension and patients presenting with STEMI. This degree of calcification was also associated with significantly higher one-year rates of death, cardiac death, definite stent thrombosis and TLR and target vessel revascularization. After adjustment, moderate/severe calcification independently predicted one-year definite stent thrombosis (hazard ratio [HR] 1.62) and ischemic TLR (HR 1.44).

They also found that PCI in patients with moderate or severe calcification was associated with suboptimal angiographic results and procedural complications compared with PCI in patients with mild calcification or no calcification.

“Novel approaches are urgently needed to improve outcomes of high-risk ACS patients with calcified lesions undergoing PCI,” the authors stressed.