JACC. Cardiovascular interventions · 2016
Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: From the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Giustino Gennaro, Mastoris Ioannis, Baber Usman, Sartori Samantha, Stone Gregg W, Leon Martin B, Serruys Patrick W, Kastrati Adnan, Windecker Stephan, Valgimigli Marco, Dangas George D, Von Birgelen Clemens, Smits Pieter C, Kandzari David, Galatius Soren, Wijns William, Steg P Gabriel, Stefanini Giulio G, Aquino Melissa, Morice Marie-Claude, Camenzind Edoardo, Weisz Giora, Jeger Raban V, Kimura Takeshi, Mikhail Ghada W, Itchhaporia Dipti, Mehta Laxmi, Ortega Rebecca, Kim Hyo-Soo, Chieffo Alaide, Mehran Roxana
Аннотация
OBJECTIVES: The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES).
BACKGROUND: The clinical correlates and the prognostic significance of CAC in women undergoing percutaneous coronary intervention with DES remain unclear.
METHODS: Patient-level data from female participants in 26 randomized trials of DES were pooled. Study population was categorized according to the presence of moderate or severe versus mild or no target lesion CAC, assessed through coronary angiography. Co-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: Among 11,557 women included in the pooled dataset, CAC status was available in 6,371 women. Of these, 1,622 (25.5%) had moderate or 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: 1.56; 95% confidence interval: 1.33 to 1.84; p < 0.0001) and death, MI, or stent thrombosis (12.7% vs. 8.6%; adjusted hazard ratio: 1.48; 95% confidence interval: 1.21 to 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: Women undergoing PCI of calcified lesions tend to have worse clinical profile and remain at increased ischemic risk, irrespective of new-generation DES.
BACKGROUND: The clinical correlates and the prognostic significance of CAC in women undergoing percutaneous coronary intervention with DES remain unclear.
METHODS: Patient-level data from female participants in 26 randomized trials of DES were pooled. Study population was categorized according to the presence of moderate or severe versus mild or no target lesion CAC, assessed through coronary angiography. Co-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: Among 11,557 women included in the pooled dataset, CAC status was available in 6,371 women. Of these, 1,622 (25.5%) had moderate or 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: 1.56; 95% confidence interval: 1.33 to 1.84; p < 0.0001) and death, MI, or stent thrombosis (12.7% vs. 8.6%; adjusted hazard ratio: 1.48; 95% confidence interval: 1.21 to 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: Women undergoing PCI of calcified lesions tend to have worse clinical profile and remain at increased ischemic risk, irrespective of new-generation DES.
Предметные рубрики MeSH
AgedAged, 80 and overCoronary AngiographyCoronary Artery DiseaseCoronary ThrombosisDrug-Eluting StentsEvidence-Based MedicineFemaleHumansKaplan-Meier EstimateLogistic ModelsMiddle AgedMyocardial InfarctionOdds RatioPercutaneous Coronary InterventionProportional Hazards ModelsProsthesis DesignRandomized Controlled Trials as TopicRisk AssessmentRisk FactorsSeverity of Illness IndexSex FactorsTime FactorsTreatment OutcomeVascular Calcification