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JACC Cardiovasc Interv. 2016 Sep 26;9(18):1890-901. doi: 10.1016/j.jcin.2016.06.022.

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.

Author information

1
Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
2
Department of Cardiology, Columbia University Medical Center, New York, New York.
3
Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands.
4
Department of Cardiology, Herzzentrum, Munich, Germany.
5
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
6
Department of Cardiology, Thoraxcentrum Twente, Enschede, the Netherlands.
7
Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands.
8
Piedmont Heart Institute, Atlanta, Georgia.
9
Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
10
Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium.
11
Département Hospitalo Universitaire Fibrose, Inflammation et Remodelage, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U114, Paris, France.
12
Division of Clinical and Interventional Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy.
13
Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Paris, France.
14
Department of Cardiology, Institut Lorrain du Coeur et des Vaisseaux University Hospital Nancy - Brabois, Vandoeuvre-lès-Nancy, France.
15
Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel; Columbia University Medical Center, New York, New York.
16
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
17
Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
18
Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
19
Department of Cardiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California.
20
Department of Cardiology, The Ohio State University Medical Center, Columbus, Ohio.
21
Duke Clinical Research Institute, Durham, North Carolina.
22
Department of Cardiology, Seoul National University Main Hospital, Seoul, Korea.
23
Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy.
24
Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: roxana.mehran@mountsinai.org.

Abstract

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.

KEYWORDS:

DES; PCI; coronary artery calcifications; women

PMID:
27659564
DOI:
10.1016/j.jcin.2016.06.022
[Indexed for MEDLINE]
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