Percutaneous coronary intervention of moderate to severe calcified coronary lesions: Insights from the National Heart, Lung, and Blood Institute Dynamic Registry
- 22 December 2010
- journal article
- research article
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 77 (1), 22-28
- https://doi.org/10.1002/ccd.22613
Abstract
Objectives: To evaluate the efficacy and safety of drug eluting stents (DES) when compared with bare metal stents (BMS) in patients with moderate to severe calcified coronary lesions. Background: Calcified coronary lesions present unique technical challenges during percutaneous coronary intervention (PCI) and it is not known if DES are as safe and as effective in the presence of calcium, as randomized trials typically exclude this common patient subset. Methods: We evaluated patients with PCI of a single calcified lesion enrolled across five recruitment waves in the National Heart, Lung, and Blood Institute Dynamic Registry between 1997 and 2006. Patients were divided into two groups based on the stent type‐ BMS and DES. The primary efficacy outcome was the need for repeat revascularization at 1 year and the primary safety outcome was a composite of death and myocardial infarction at 1 year. Results: Among the 1,537 patients included in the analysis, 884 (57%) underwent PCI with BMS and 653 (43%) with DES. DES use was associated with a significant reduction in the risk of repeat revascularization (10.0% vs. 15.3%; P = 0.003) with no significant higher risk of primary safety outcome (9.3% vs. 10.5%; P = 0.45) when compared to the BMS group. In a propensity score adjusted analysis, DES use was associated with a significantly lower risk in repeat revascularization (HR = 0.57; 95% CI 0.40–0.82; P = 0.002) and no significant difference in the risk of death and myocardial infarction (HR = 0.78; 95% CI 0.53–1.15; P = 0.20) compared to BMS group. Conclusion: In this large multicenter registry of patients with a moderate to severe calcified coronary lesion, use of DES compared to BMS was associated with significant reduction in the risk of repeat revascularization without any increase in death and myocardial infarction.Keywords
This publication has 15 references indexed in Scilit:
- Impact of lesion calcification on clinical and angiographic outcome after sirolimus-eluting stent implantation in real-world patientsCardiovascular Revascularization Medicine, 2008
- Angiographic Surrogate End Points in Drug-Eluting Stent Trials: A Systematic Evaluation Based on Individual Patient Data From 11 Randomized, Controlled TrialsJournal of the American College of Cardiology, 2008
- Use of Propensity Score Technique to Account for Exposure-Related CovariatesMedical Care, 2007
- Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting Stents: An Observational Study of Drug-Eluting Versus Bare-Metal StentsJournal of the American College of Cardiology, 2006
- Results of Multivariable Logistic Regression, Propensity Matching, Propensity Adjustment, and Propensity-based Weighting under Conditions of Nonuniform EffectAmerican Journal of Epidemiology, 2005
- Impact of Coronary Culprit Lesion Calcium in Patients Undergoing Paclitaxel-Eluting Stent Implantation (a TAXUS-IV Sub Study)The American Journal of Cardiology, 2005
- A Polymer-Based, Paclitaxel-Eluting Stent in Patients with Coronary Artery DiseaseNew England Journal of Medicine, 2004
- Sirolimus-Eluting Stents versus Standard Stents in Patients with Stenosis in a Native Coronary ArteryNew England Journal of Medicine, 2003
- Coronary angioplasty from the perspective of atherosclerotic plaque: Morphologic predictors of immediate success and restenosisAmerican Heart Journal, 1994
- In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty.Circulation, 1985