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CAC linked with higher risk profile in women undergoing PCI with DES
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Women undergoing PCI with drug-eluting stents who have moderate or severe coronary artery calcification exhibit a higher clinical risk profile compared with those without coronary artery calcification, and they continue to be at elevated risk for mid- to long-term MACE, including death.
Gennaro Giustino, MD, of the Zena and Michael A. Wiener Cardiovascular Institute at Icahn School of Medicine at Mount Sinai, New York, and colleagues evaluated patient-level data of 6,371 women with available coronary artery calcification (CAC) information pooled from 26 randomized trials of DES. The researchers stratified the study population based on the existence of moderate or severe vs. mild or no target lesion CAC as evaluated through coronary angiography.
The study’s co-primary endpoints were the composite of death, MI or target lesion revascularization and death, MI or stent thrombosis at 3-year follow-up. Secondary endpoints consisted of the individual constituents of the two co-primary endpoints and cardiac death. The researchers assessed the effects of CAC on the two co-primary endpoints in the following subgroups: age older than 65 years, diabetes, prior MI, chronic kidney disease, smoking status, CAD presentation, implantation of more than two DES, stent length longer than 30 mm, bifurcation lesion as target vessel and DES generation.
Overall, 1,622 women (25.5%) included in the analysis had moderate or severe CAC. The women with moderate or severe CAC were significantly older and had higher rates of hypertension, hypercholesterolemia, prior CABG, higher serum creatinine and lower left ventricular ejection fraction. Stable CAD was more common in women with CAC. Higher rates of multivessel disease were seen in women with moderate or severe CAC, and these women also had a larger number of lesions treated, stents implanted and bifurcation lesion as a target vessel.
At 3-year follow-up, risk for death, MI or TLR was higher in women with CAC vs. those without (18.2% vs. 13.1%, adjusted HR = 1.56; 95% CI, 1.33-1.84). Compared with women without CAC, those with CAC also carried increased risk for mortality, MI or stent thrombosis (12.7% in CAC patients vs. 8.6% in non-CAC patients; adjusted HR = 1.48; 95% CI, 1.21-1.8).
Moderate or severe CAC was linked to an increased risk for death, cardiac death, spontaneous MI and TLR. Although moderate or severe CAC was linked to a higher unadjusted risk of definite or probable stent thrombosis (1.5% vs. 0.9%; univariate HR = 1.73; 95% CI, 1.05-2.86), this association was diminished after multivariable adjustment (adjusted HR = 1.52; 95% CI, 0.89-2.59).
In a related editorial, Cindy L. Grines, MD, from the department of cardiology at Detroit Medical Center Heart Hospital, and Kimberly A. Skelding, MD, of Geisinger Medical Center in Danville, Pennsylvania, noted a link between CAC in women and osteoporosis.
“There is a very strong correlation among osteoporosis, vascular calcification and [CV] events, with similar complex causal mechanisms,” Grines and Skelding. “Moreover, because women are at higher risk than men for the development of osteoporosis, they are often prescribed calcium supplements starting well before menopause. Some studies suggest high-dose calcium supplements may increase the risk of MI and [CV] events.” – by Jennifer Byrne,
Disclosure: Giustino reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures. Skelding reports consulting for Abbott and being a proctor for Medtronic.
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