文摘
The impact of lesion calcium on long-term outcomes after drug-eluting stent implantation has not been adequately addressed. In 10,595 patients (16,803 lesions) who were exclusively treated with sirolimus-eluting stents in the j-Cypher registry, 5-year outcomes were compared between patients with ¡Ý1 lesion with moderate or severe calcification (the calcium group) and those with noncalcified lesions only (the noncalcium group). Analyses were stratified by hemodialysis (HD) status (non-HD stratum [calcium n?= 3,191, noncalcium n?= 6,824] and HD stratum [calcium n?= 415, noncalcium n?= 165]). Adjusted risk in the calcium group for death and target lesion revascularization was significant in the non-HD stratum (hazard ratio [HR] 1.34, 95 % confidence interval [CI] 1.18 to 1.52, p?<0.0001, and HR 1.2, 95 % CI 1.07 to 1.36, p?= 0.003) and the HD stratum (HR 1.4, 95 % CI 1.06 to 1.86, p?= 0.02, and HR 2.25, 95 % CI 1.51 to 3.36, p <0.0001). Risk for definite stent thrombosis tended to be higher in the calcium group in the HD stratum (HR 5.05, 95 % CI 0.66 to 38.9, p?= 0.12) but not in then non-HD stratum (HR 1.16, 95 % CI 0.81 to 1.67, p?= 0.41). The use of rotational atherectomy in patients with severe calcification did not have a significant impact on the cumulative incidence of target lesion revascularization in the non-HD stratum (17.7 % [n?= 268] with vs 18.2 % [n?= 588] without rotational atherectomy, p?= 0.68) and the HD stratum (54.7 % [n?= 115] with vs 51.9 % [n?= 118] without rotational atherectomy, p?= 0.19). In conclusion, regardless of HD status, patients with calcified lesions have increased long-term risk for death and target lesion revascularization after sirolimus-eluting stent implantation.
