Impact of Coronary Artery Calcification in STEMI Patients Undergoing Primary PCI

Gabriel Greenberg Ran Kornowski Hana Vaknin Assa Tamir Bental Eeldad Rechavia Eli Lev Abid Assali
Cardiology, Rabin Medical Center, Petach-Tikva, Israel

Background and Objectives: Treatment of calcified coronary arteries is associated with poorer angiographic results and higher rate of complications as compared with non-calcified arteries. Little is known about the impact of coronary calcification on outcomes after percutaneous coronary intervention (PCI) for patients presenting with acute myocardial infarction(AMI). We sought to determine the frequency and impact of coronary artery calcification(CAC) among patients undergoing primary PCI (PPCI) for STEMI.

Methods: We analyzed 2143 consecutive patients presenting to our hospital with STEMI and that underwent PPCI within 12 hours of chest pain. Patients were divided into two groups, one with moderate or severe CAC (14%) and the second without CAC. We analyzed their clinical characteristics and one year outcome including death, MI, Stent Thrombosis, Target Vessel Revascularization and MACE.

Results: Patients with CAC were older, sicker, and had poorer final angiographic results (see table). They had higher one year requirement for coronary artery bypass grafting (7.2% vs. 3.5%, p=0.003)

Patients without CAC had lower MACE rates (17.5% vs. 24%, p=0.01) driven by lower mortality (4.7% vs. 8.5%, p=0.008).

Conclusions: In STEMI PCI, CAC is associated with poorer angiographic and clinical outcomes compared with lesser or non-calcified coronary arteries.

Table:

p-Value

Calcified

(n=306)

Non-calcified

(n=1837)

Variables

0.001

±6813

12±59

Age

0.0001

74

84

Male (%)

0.08

30

25

Diabetes Mellitus (%)

0.0001

22

11

Renal Failure (%)

0.0001

61

43

Anterior MI (%)

0.001

70

57

Two/Three vessel disease(%)

0.001

17

11

Killip>1

0.0001

6.1±3.9

3.8±3.3

Cadillac score

0.0001

90

97

Final TIMI 3(%)

0.05

94

96

Stenting (%)









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