TCT@ACC-i2: The Interventional Learning Pathway

A1851JACC April 1, 2014

Volume 63, Issue 12

outcoMes After PercutAneous coronAry interVentions [Pci] bAseD on seVerity of coronAry Artery cAlcificAtion [cAc]

Poster ContributionsHall CSunday, March 30, 2014, 3:45 p.m.-4:30 p.m.

Session Title: Complexities and ComplicationsAbstract Category: 38. TCT@ACC-i2: Complex Patients/ComorbiditiesPresentation Number: 2108-289

Authors: Anitha Rajamanickam, Christopher Varughese, Antony Innasimuthu, Mayur Lakhani, Rahul Sawant, Ravinder Rao, Jimmy Yee, Choudhury Hasan, Joseph Sweeny, Usman Baber, Robert Pyo, Pedro Moreno, Samin Sharma, Annapoorna Kini, Mount Sinai Medical Center, New York, NY, USA, Mount Sinai Medical Center, New York, NY, USA

background: CAC ,a marker of future cardiovascular events, is a major challenge for achieving a successful PCI. CAC may cause stent underexpansion and increase the risk of restenosis, thrombosis, and target-lesion revascularization [TLR]. We sought to analyze long term outcomes of PCI in lesions based on degree of calcification.

Methods: Retrospective analysis of our prospectively collected database from 1/1/2010 - 6/12/2012 retrieved 7879 patients with 1 year completed follow up [8% with severe CAC, 8% with moderate CAC and 84% with no/mild CAC]

RESULTS : Cutting balloon angioplasty or rotational atherectomy were used in 100% of severe CAC and in 52% of moderate CAC. When compared to no/mild CAC, moderate and severe CAC were more likely to be chronic total occlusions, longer, bifurcation, left main or left anterior descending artery lesions while less likely to present as acute myocardial infarction or instent restenosis. There was no difference in overall major complications [13.5% vs 15.6, p= 0.6066]. Lesions with moderate/severe CAC had higher residual stenosis [ 18% vs 12% , p= <.0001]. See table 1 for outcomes.

conclusion: Patients with moderate to severe calcification had higher 30 day and 1 year mortality which could not be explained by residual stenosis as periprocedural complications and 1 year MI,TLR and TVR were similar to no/mild CAC. CAC is an independent risk factor for mortality after PCI.