Impact of calcification on percutaneous coronary intervention: MACE‐Trial 1‐year results

• Published in: Catheterization and cardiovascular interventions Vol. 94; no. 2; pp. 187 - 194
• Main Authors: Sharma, Samin K., Bolduan, Ryan W., Patel, Manesh R., Martinsen, Brad J., Azemi, Talhat, Giugliano, Gregory, Resar, Jon R., Mehran, Roxana, Cohen, David J., Popma, Jeffrey J., Waksman, Ron
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.08.2019; Wiley Subscription Services, Inc
• Subjects: Angioplasty; atherectomy; Calcification; Calcification (ectopic); Calcium; coronary artery calcification; Epidermal growth factor receptors; percutaneous coronary intervention; Studies; Success; percutaneous coronary intervention; atherectomy; coronary artery calcification
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.28099

Objectives The Multi‐center Prospective Study to Evaluate Outcomes of Moderate to Severely Calcified Coronary Lesions (MACE—Trial) was designed to provide further insight on the impact of calcification on procedural and long‐term percutaneous coronary intervention outcomes. Background Prior studies evaluating the impact of lesion calcification on percutaneous coronary intervention outcomes are limited by: retrospective nature, pooled data from multiple studies, or lack of specificity around calcification with only operator assessment and without core lab evaluation. Methods The MACE‐Trial was a prospective, multicenter, observational clinical study that enrolled 350 subjects at 33 sites from September 2013 to September 2015. Core lab assessed subject stratification by lesion calcification (none/mild [N = 133], moderate [N = 99], and severe [N = 114]). Endpoints were lesion success, procedural success, and 1‐year major adverse cardiac events (MACEs). Results Presence of severe calcification had significant impact on lesion success ([83.3%] versus none/mild calcification [94.7%, P = 0.006]) and procedural success ([86.8%] versus moderate [95.0%, P = 0.028], and none/mild [97.7%, P = 0.001]). 1‐year MACE rates were associated with presence of calcification in subjects with none/mild (4.7%), moderate (8.7%), and severe (24.4%) (P < 0.001) calcification; however, no difference was noted between none/mild and moderate (P = 0.237). The risk adjusted multivariable model identified severe calcification and decreasing eGFR as predictors of 30‐day and 1‐year MACE. Conclusions In this prospective study, patients with severe calcification had significantly worse outcomes compared to those without; however, unlike previous retrospective studies, moderate calcium resulted in similar outcomes as none/mild calcium. Clinical Trial Registration URL: https://clinicaltrials.gov/ct2/show/NCT01930214. Unique Identifier: NCT01930214.