Two-year outcome after treatment of severely calcified lesions with newer-generation drug-eluting stents in acute coronary syndromes

Abstract

In patients with ACS, treatment of severely calcified lesions with newer-generation DES was associated with an overall higher clinical event risk - related in particular to a higher TVR rate, while the risk of MI was low.

Three contemporary thin‐strut drug‐eluting stents implanted in severely calcified coronary lesions of participants in a randomized all‐comers trial

“…Risk factors contributing to the development of coronary calcification include advanced age, diabetes, male sex and renal dysfunction. Coronary artery calcification, which can be found in 20–30% of all patients who undergo PCI, 2‐6 may result in a reduced vascular compliance and impair myocardial perfusion 1…”

Acute coronary syndrome – Still a valid contraindication to perform rotational atherectomy? Early and one-year outcomes

“…Recent studies showed the 17-32% prevalence of moderate to severe coronary calcifications in this population [6,7]. The outcomes in this group are unfavorable, that is related to unsuccessful lesion preparation, stent delivery and expansion with subsequent procedure failure, target vessel failure, risk of restenosis, and stent thrombosis [8][9][10].…”

Second-Generation vs. First-Generation Drug-Eluting Stents in Patients With Calcified Coronary Lesions ― Pooled Analysis From the RESET and NEXT Trials ―

“…The prevalence of lesion calcification was reported to be 19-32% in recent pooled analyses and metaanalyses of studies in patients with different clinical presentations. [14][15][16][17][18] Calcified lesions were slightly low, at 21.9%, in the present study, suggesting that the population of this study might have had a lower risk profile than previous studies, although both the RESET and NEXT had an allcomer study design. Nevertheless, worse clinical outcomes in patients with calcified lesions were observed in the present study, in which a large number of patients with moderate to severe calcification in real-world clinical practice were treated with G1-DES and G2-DES.…”

“…[27][28][29] Moreover, most all-comer randomized trials have not analyzed coronary calcification at an angiography core laboratory. Therefore, there have been only a few previous observational studies that have investigated the efficacy of DES in calcified lesions, 14,[16][17][18] and these have suggested that lesion calcification is associated with worse clinical outcome. The prevalence of lesion calcification was reported to be 19-32% in recent pooled analyses and metaanalyses of studies in patients with different clinical presentations.…”

“…9-14 Moreover, worse clinical outcomes have been suggested for calcified lesions than for non-calcified lesions even after treatment with second-generation drug-eluting stents (G2-DES) despite their improved delivery, flexibility, and more biocompatible polymer composition. [15][16][17][18] Several previous randomized controlled trials suggested noninferiority of G2-DES to G1-DES for TLR, and a metaanalysis demonstrated superiority of G2-DES for TLR in patient populations including both calcified and noncalcified lesions. [19][20][21][22] However, there has not been a study comparing G2-DES with G1-DES in patients with lesion calcification.…”