Severe Calcification Predicts Poor Prognosis in Obstructive Coronary Artery Disease

Surgical Rounds®, June 2014,

Severe coronary calcification is an independent predictor of worse prognosis in obstructive coronary artery disease patients undergoing percutaneous coronary intervention.

What initially appears as soft, unstable artery plaque can rupture and calcify over time, indicating advanced atherosclerosis.

In a recent issue of BMJ Heart, researchers from the Netherlands published a study on coronary calcification’s long-term prognostic implications for obstructive coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI).

Although previous studies have looked at the efficacy of drug-eluting stents (DES) in heavily calcified lesions, some demonstrated marked reduction in lesion revascularization, while others reported patients with calcified lesions are more likely to develop stent thrombosis and major adverse events.

For the current study, researchers analyzed data on 6,296 CAD patients from 7 DES trials and identified those with severe coronary calcification. Their endpoints at 3-years follow-up included all-cause mortality, death from myocardial infarction (MI), and a composite of mortality from any cause, MI, or any revascularization.

According to the authors, the 20% of patients who had severe calcification were significantly less likely to have undergone complete revascularization and had higher mortality rates than with those without it. Additionally, patients with severely calcified lesions were more than twice as likely to experience the combined endpoint of death from MI and significantly more likely to experience all-cause mortality, MI, or any revascularization. Nevertheless, the presence of severely calcified lesions was not linked to an increased risk of stent thrombosis.

In light of their findings, the investigators concluded severe coronary calcification was an “independent predictor of worse prognosis, and should be considered as a marker of advanced atherosclerosis.”