Prognostic Implications of Severe Lesion Calcification in Patients Undergoing Percutaneous Coronary Intervention

Bourantas, Christos V.; Garg, Scot; Iqbal, Javaid; Zhang, Yaojun; Valgimigli, Marco; Windecker, Stephan; Mohr, Friedrich; Silber, Sigmund; Vries, Ton de; Onuma, Yoshinobu; García‐García, Héctor M.; Morel, Marie Angèle; Serruys, Patrick W.

doi:10.1016/s0735-1097(14)61851-9

Cited by 2 publications

(3 citation statements)

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“…However, it is reported that target lesion calcification was associated with stent underexpansion (20), which is a known risk factor for stent restenosis and stent thrombosis (21,22). Even among the newer generation DES, coronary calcification was associated with unfavorable clinical outcomes after PCI (3)(4)(5). In previous reports, the major adverse composite endpoints at 1 year in lesions with moderate to severe calcification was reported to be 10.7-20.9%.…”

Section: Discussionmentioning

confidence: 99%

“…They adversely interfered with the ability to cross or dilate a coronary stenosis with PCI devices such as balloons or stents, leading to poor acute outcomes including stent thrombosis (1,2). Despite recent advancements in drug eluting stents (DES), target lesion failure after PCI of calcified lesions remains high, ranging from 10.7 to 20.9% (3)(4)(5). Recently, several studies have demonstrated that intravascular ultrasound (IVUS) improved outcomes after PCI (6)(7)(8), especially in complex lesions (9,10).…”

Section: Introductionmentioning

confidence: 99%

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Impact of Calcium Cracks after Balloon Angioplasty in Patients with Complex Calcified Coronary Plaque ∼The Results of the OCT-CALC Registry∼

Maejima,

Endo,

Ashikaga

et al. 2024

Preprint

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BackgroundTarget lesion calcification is known to influence the percutaneous coronary intervention (PCI) outcomes. Calcium cracks as assessed by optical coherence tomography (OCT) after balloon angioplasty were associated with a larger stent area and a larger lumen gain after PCI for the lesions with moderate to severe calcification, although clinical outcomes in those patients remain unclear. This study aimed to assess the impact of calcium cracks after balloon angioplasty on the PCI results as well as the long-term clinical outcomes by multicenter OCT-guided PCI registry.MethodsWe formed a prospective, multicenter registry that include 22 sites from Japan and Korea that enrolled 268 patients who underwent PCI to the lesion with moderate to severe calcification on angiogram. Balloon dilatation and subsequent drug elution stent (DES) implantation were performed with OCT guidance in every case. Lesion modification with rotational atherectomy was performed before balloon dilatation if needed. Serial OCT images just before and after balloon angioplasty, and after stent implantation were analyzed at 1-mm intervals by an independent core laboratory. The incidence of calcium cracks after balloon angioplasty was assessed at the minimal lumen area (MLA) site by OCT. By protocol, follow-up angiography was performed 10 months after PCI (in 85.5% of patients), and both baseline and follow-up angiograms were analyzed by an angiographic core laboratory. The primary endpoint was the relationship between calcium crack after balloon angioplasty and stent expansion. The secondary endpoint was target vessel failure (TVF) at 1 year, defined as a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization.ResultsA total of 242 patients were analyzed. Of these, OCT analysis was performed in 147 patients with a complete OCT data set. Calcium cracks were observed in 28 patients (19%) at the MLA site. The percent stent expansion was greater in lesions with calcium crack than those without (99±26 % vs. 91±18 %, p=0.039). In 229 patients who underwent clinical follow-up at 1 year, TVF occurred in 23 patients (10.0%). In 139 patients in whom both OCT analysis and 1-year clinical follow-up was performed, the incidence of TVF was similar between patients with and without crack formation (11 % vs. 13 %, p=1.00). Angiographic sub-analysis with both baseline and 10-months follow-up was performed in 124 patients. Acute lumen gain, as well as late lumens loss, were greater in patients with calcium crack than those without (1.39±0.55 mm vs. 1.15±0.48 mm, p=0.037; 0.51±0.67 mm vs. 0.12±0.51 mm, p=0.0095, respectively), resulting in similar net lumen gains between the 2 groups.ConclusionThe OCT-guided PCI strategy demonstrated acceptable acute and 1-year clinical outcomes. The presence of calcium cracks after balloon angioplasty may have a potential impact on acute results after DES implantation in calcified lesions. However, its impact may be attenuated by late lumen loss at 10-months follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Calcium Cracks after Balloon Angioplasty in Patients with Complex Calcified Coronary Plaque ∼The Results of the OCT-CALC Registry∼

Maejima,

Endo,

Ashikaga

et al. 2024

Preprint

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“…25,26 Early detection of CAC is important for identifying subclinical atherosclerosis and predict the risk of CAD. 25,27 By identifying specific circulating miRNAs for CAC, we are providing a novel way of identifying the severity of CAC which can also function as potential biomarkers for the presence of obstructive CAD. Moreover, the results of the current study highlight that further insight into the function of circulating miRNAs in the process and progression of CAC.…”

Section: Discussionmentioning

confidence: 99%

Circulatory microRNA expression profile for coronary artery calcification in chronic kidney disease patients

Vijayaraghavan¹,

Jeyamohan²,

Padmanabhan³

et al. 2021

Afr H. Sci.

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Background & Aim: Coronary artery disease (CAD) is the primary cause of mortality in patients with end stage renal disease (ESRD). MicroRNA profiling is proven as a powerful tool in the diagnosis of any disease at the molecular level. Hence, the present study aimed to profile the microRNA expression for CAD especially coronary artery calcification in CKD patients. Materials and Methods: Two hundread patients with CKD stages 3 to 5 without dialysis and healthy controls were includ- ed in this study. All two hundred patients underwent 1024 multi sliceardiac computed tomography (CT) scan for calcium scoring. The calcium scoring more than 100 have been included in the study. We performed miRNA microarray analysis from serum samples of seven high calcium scored with CKD patients and one control patients. Results: Seven patients have observed circulating miRNAs has significantly upregulated and downregulated when compared with control patients. mir21, mir 67, mir 390, mir 56, mir 250, mir 65 and mir 13 were up regulated and mir235, mir256, mir226, mir207, mir255, mir193 were downregulated. There was no significant difference in left ventricle function. Conclusion: 13 microRNAs play a potential role in coronary artery calcification in CKD patients. Keywords: CKD; CAD; microRNA; coronary artery calcification.

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Prognostic Implications of Severe Lesion Calcification in Patients Undergoing Percutaneous Coronary Intervention

Cited by 2 publications

References 0 publications

Impact of Calcium Cracks after Balloon Angioplasty in Patients with Complex Calcified Coronary Plaque ∼The Results of the OCT-CALC Registry∼

Impact of Calcium Cracks after Balloon Angioplasty in Patients with Complex Calcified Coronary Plaque ∼The Results of the OCT-CALC Registry∼

Circulatory microRNA expression profile for coronary artery calcification in chronic kidney disease patients

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