Two-year outcome after treatment of severely calcified lesions with newer-generation drug-eluting stents in acute coronary syndromes: A patient-level pooled analysis from TWENTE and DUTCH PEERS

Jennifer Huisman, Liefke C. van der Heijden, Marlies M. Kok, J. (Hans) W. Louwerenburg, Peter W. Danse, Gillian A.J. Jessurun, Frits H.A.F. de Man, Marije M. Löwik, Gerard C.M. Linssen, Maarten J. IJzerman, Carine J.M. Doggen, Clemens von Birgelen

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Abstract

Background: Data on medium-term outcome of patients with acute coronary syndrome (ACS), treated with newer-generation durable polymer drug-eluting stents (DES) in severely calcified coronary lesions, are scarce. We aimed to assess the impact of severe coronary lesion calcification on clinical outcome of patients with ACS, treated with newer-generation DES.

Methods: The TWENTE and DUTCH PEERS randomized trials comprise 1779 ACS patients, who were categorized into patients with versus without severe target lesion calcification. We performed a patient-level pooled analysis to assess 2-year outcome, including target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction (MI), or target vessel revascularization (TVR).

Results: Patients with severe target lesion calcification (n = 340, 19.1%) were older (66.8 ± 10.6 years vs. 62.8 ± 11.5 years, p < 0.001) and had more often diabetes (22.1% vs. 16.8%, p = 0.02) and hypercholesterolemia (51.5% vs. 42.9%, p = 0.005) than other patients (n = 1439, 79.9%). In addition they showed a higher TVF rate (12.4% vs.7.0%, p = 0.001), mainly related to a difference in TVR (6.8% vs. 3.3%, p = 0.003). There was a borderline significant between-group difference in cardiac death (3.6% vs. 1.8%, p = 0.05), but not in target vessel MI (3.8% vs.2.6%, p = 0.23) and definite stent thrombosis (0.9% vs. 0.6%, p = 0.71). Multivariate analysis demonstrated that severe lesion calcification was an independent risk factor of TVF (adjusted HR; 1.58, 95% CI: 1.23–2.03; p < 0.001).

Conclusions: 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.

Original languageEnglish
Pages (from-to)660-665
JournalJournal of cardiology
Volume69
Issue number4
DOIs
Publication statusPublished - Apr 2017

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Drug-Eluting Stents
Acute Coronary Syndrome
Myocardial Infarction
Hypercholesterolemia
Stents
Polymers
Thrombosis
Multivariate Analysis

Keywords

  • Calcified coronary lesion
  • Newer generation/second generation drug-eluting stent
  • Percutaneous coronary intervention
  • Acute coronary syndrome

Cite this

Huisman, Jennifer ; van der Heijden, Liefke C. ; Kok, Marlies M. ; Louwerenburg, J. (Hans) W. ; Danse, Peter W. ; Jessurun, Gillian A.J. ; de Man, Frits H.A.F. ; Löwik, Marije M. ; Linssen, Gerard C.M. ; IJzerman, Maarten J. ; Doggen, Carine J.M. ; von Birgelen, Clemens. / Two-year outcome after treatment of severely calcified lesions with newer-generation drug-eluting stents in acute coronary syndromes: A patient-level pooled analysis from TWENTE and DUTCH PEERS. In: Journal of cardiology. 2017 ; Vol. 69, No. 4. pp. 660-665.
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title = "Two-year outcome after treatment of severely calcified lesions with newer-generation drug-eluting stents in acute coronary syndromes: A patient-level pooled analysis from TWENTE and DUTCH PEERS",
abstract = "Background: Data on medium-term outcome of patients with acute coronary syndrome (ACS), treated with newer-generation durable polymer drug-eluting stents (DES) in severely calcified coronary lesions, are scarce. We aimed to assess the impact of severe coronary lesion calcification on clinical outcome of patients with ACS, treated with newer-generation DES.Methods: The TWENTE and DUTCH PEERS randomized trials comprise 1779 ACS patients, who were categorized into patients with versus without severe target lesion calcification. We performed a patient-level pooled analysis to assess 2-year outcome, including target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction (MI), or target vessel revascularization (TVR).Results: Patients with severe target lesion calcification (n = 340, 19.1{\%}) were older (66.8 ± 10.6 years vs. 62.8 ± 11.5 years, p < 0.001) and had more often diabetes (22.1{\%} vs. 16.8{\%}, p = 0.02) and hypercholesterolemia (51.5{\%} vs. 42.9{\%}, p = 0.005) than other patients (n = 1439, 79.9{\%}). In addition they showed a higher TVF rate (12.4{\%} vs.7.0{\%}, p = 0.001), mainly related to a difference in TVR (6.8{\%} vs. 3.3{\%}, p = 0.003). There was a borderline significant between-group difference in cardiac death (3.6{\%} vs. 1.8{\%}, p = 0.05), but not in target vessel MI (3.8{\%} vs.2.6{\%}, p = 0.23) and definite stent thrombosis (0.9{\%} vs. 0.6{\%}, p = 0.71). Multivariate analysis demonstrated that severe lesion calcification was an independent risk factor of TVF (adjusted HR; 1.58, 95{\%} CI: 1.23–2.03; p < 0.001).Conclusions: 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.",
keywords = "Calcified coronary lesion, Newer generation/second generation drug-eluting stent, Percutaneous coronary intervention, Acute coronary syndrome",
author = "Jennifer Huisman and {van der Heijden}, {Liefke C.} and Kok, {Marlies M.} and Louwerenburg, {J. (Hans) W.} and Danse, {Peter W.} and Jessurun, {Gillian A.J.} and {de Man}, {Frits H.A.F.} and L{\"o}wik, {Marije M.} and Linssen, {Gerard C.M.} and IJzerman, {Maarten J.} and Doggen, {Carine J.M.} and {von Birgelen}, Clemens",
year = "2017",
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language = "English",
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number = "4",

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Two-year outcome after treatment of severely calcified lesions with newer-generation drug-eluting stents in acute coronary syndromes: A patient-level pooled analysis from TWENTE and DUTCH PEERS. / Huisman, Jennifer; van der Heijden, Liefke C.; Kok, Marlies M.; Louwerenburg, J. (Hans) W.; Danse, Peter W.; Jessurun, Gillian A.J.; de Man, Frits H.A.F.; Löwik, Marije M.; Linssen, Gerard C.M.; IJzerman, Maarten J.; Doggen, Carine J.M.; von Birgelen, Clemens.

In: Journal of cardiology, Vol. 69, No. 4, 04.2017, p. 660-665.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Two-year outcome after treatment of severely calcified lesions with newer-generation drug-eluting stents in acute coronary syndromes: A patient-level pooled analysis from TWENTE and DUTCH PEERS

AU - Huisman, Jennifer

AU - van der Heijden, Liefke C.

AU - Kok, Marlies M.

AU - Louwerenburg, J. (Hans) W.

AU - Danse, Peter W.

AU - Jessurun, Gillian A.J.

AU - de Man, Frits H.A.F.

AU - Löwik, Marije M.

AU - Linssen, Gerard C.M.

AU - IJzerman, Maarten J.

AU - Doggen, Carine J.M.

AU - von Birgelen, Clemens

PY - 2017/4

Y1 - 2017/4

N2 - Background: Data on medium-term outcome of patients with acute coronary syndrome (ACS), treated with newer-generation durable polymer drug-eluting stents (DES) in severely calcified coronary lesions, are scarce. We aimed to assess the impact of severe coronary lesion calcification on clinical outcome of patients with ACS, treated with newer-generation DES.Methods: The TWENTE and DUTCH PEERS randomized trials comprise 1779 ACS patients, who were categorized into patients with versus without severe target lesion calcification. We performed a patient-level pooled analysis to assess 2-year outcome, including target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction (MI), or target vessel revascularization (TVR).Results: Patients with severe target lesion calcification (n = 340, 19.1%) were older (66.8 ± 10.6 years vs. 62.8 ± 11.5 years, p < 0.001) and had more often diabetes (22.1% vs. 16.8%, p = 0.02) and hypercholesterolemia (51.5% vs. 42.9%, p = 0.005) than other patients (n = 1439, 79.9%). In addition they showed a higher TVF rate (12.4% vs.7.0%, p = 0.001), mainly related to a difference in TVR (6.8% vs. 3.3%, p = 0.003). There was a borderline significant between-group difference in cardiac death (3.6% vs. 1.8%, p = 0.05), but not in target vessel MI (3.8% vs.2.6%, p = 0.23) and definite stent thrombosis (0.9% vs. 0.6%, p = 0.71). Multivariate analysis demonstrated that severe lesion calcification was an independent risk factor of TVF (adjusted HR; 1.58, 95% CI: 1.23–2.03; p < 0.001).Conclusions: 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.

AB - Background: Data on medium-term outcome of patients with acute coronary syndrome (ACS), treated with newer-generation durable polymer drug-eluting stents (DES) in severely calcified coronary lesions, are scarce. We aimed to assess the impact of severe coronary lesion calcification on clinical outcome of patients with ACS, treated with newer-generation DES.Methods: The TWENTE and DUTCH PEERS randomized trials comprise 1779 ACS patients, who were categorized into patients with versus without severe target lesion calcification. We performed a patient-level pooled analysis to assess 2-year outcome, including target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction (MI), or target vessel revascularization (TVR).Results: Patients with severe target lesion calcification (n = 340, 19.1%) were older (66.8 ± 10.6 years vs. 62.8 ± 11.5 years, p < 0.001) and had more often diabetes (22.1% vs. 16.8%, p = 0.02) and hypercholesterolemia (51.5% vs. 42.9%, p = 0.005) than other patients (n = 1439, 79.9%). In addition they showed a higher TVF rate (12.4% vs.7.0%, p = 0.001), mainly related to a difference in TVR (6.8% vs. 3.3%, p = 0.003). There was a borderline significant between-group difference in cardiac death (3.6% vs. 1.8%, p = 0.05), but not in target vessel MI (3.8% vs.2.6%, p = 0.23) and definite stent thrombosis (0.9% vs. 0.6%, p = 0.71). Multivariate analysis demonstrated that severe lesion calcification was an independent risk factor of TVF (adjusted HR; 1.58, 95% CI: 1.23–2.03; p < 0.001).Conclusions: 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.

KW - Calcified coronary lesion

KW - Newer generation/second generation drug-eluting stent

KW - Percutaneous coronary intervention

KW - Acute coronary syndrome

U2 - 10.1016/j.jjcc.2016.06.010

DO - 10.1016/j.jjcc.2016.06.010

M3 - Article

VL - 69

SP - 660

EP - 665

JO - Journal of cardiology

JF - Journal of cardiology

SN - 0914-5087

IS - 4

ER -