Impact of severe lesion calcification on clinical outcome of patients with stable angina, treated with newer generation permanent polymer-coated drug-eluting stents: A patient-level pooled analysis from TWENTE and DUTCH PEERS (TWENTE II)

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• 作者：Jennifer Huisman ; MD^a ; Liefke C. van der Heijden ; MD^a ; Marlies M. Kok ; MD^a ; Peter W. Danse ; MD ; PhD^b ; Gillian A.J. Jessurun ; MD ; PhD^c ; Martin G. Stoel ; MD ; PhD^a ; K. Gert van Houwelingen ; MD^a ; Marije M. Lö ; wik ; PhD^a ; Raymond W.M. Hautvast ; MD ; PhD^d ; Maarten J. IJzerman ; PhD^e ; Carine J. Doggen ; PhD^e ; Clemens von Birgelen ; MD ; PhD^a ; ^e ; ^{c.vonbirgelen@mst.nl" class="auth_mail" title="E-mail the corresponding author}
• 关键词：DES ; drug-eluting stent ; MACE ; major adverse cardiac events ; MI ; myocardial infarction ; PCI ; percutaneous coronary intervention ; POCE ; patient-oriented clinical endpoint ; TLF ; target lesion failure ; TLR ; target lesion revascularization ; TVF ; target vessel failure ; TVR ; target vessel revascularization
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：175
• 期：Complete
• 页码：121-129
• 全文大小：553 K

文摘

The outcome of percutaneous coronary intervention with newer generation permanent polymer-coated drug-eluting stents (DES) in patients with severely calcified lesions is greatly unknown. We assessed the impact of severe lesion calcification on clinical outcome in patients with stable angina who underwent percutaneous coronary intervention with newer generation DES.

Methods

TWENTE and DUTCH PEERS randomized trials enrolled 1423 patients with stable angina, who were categorized into patients with versus without severe target lesion calcification. A patient-level pooled analysis assessed clinical outcome, including target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization (TVR).

Results

Patients with severe calcification (n = 342) were older (66.6 ± 9.1 vs 64.2 ± 9.8 years, P < .001) and had more diabetes (25.7% vs 20.4%, P = .04) than other patients (n = 1081). Patients with calcified lesions had higher rates of TVF (16.4% vs 9.8%, pLogrank = .001), cardiac death (4.4% vs 1.5%, P = .03), target vessel myocardial infarction (7.6% vs 3.4%, P = .001), and definite stent thrombosis (1.8% vs 0.4%, P = .02). Multivariate analysis demonstrated that severe calcification was an independent risk factor of 2-year TVF (HR 1.42, 95% CI: 1.02-1.99, pLogrank = .04); landmark analysis showed that this was based on a difference during the first year (periprocedural: 5.8% vs. 3.1%, pLogrank = .02; first year: 7.5% vs. 3.8%, pLogrank = .007; second year: 4.1% vs. 3.3%, pLogrank = .54).

Conclusion

In patients with stable angina, severe target lesion calcification is associated with an increased risk of adverse cardiovascular events following treatment with newer generation permanent polymer-coated DES. This increase in risk is restricted to the first year of follow-up, which is an encouraging finding.