Coronary calcification in patients presenting with acute coronary syndromes: insights from the MATRIX trial-Reference-Cited by-同舟云学术

Coronary calcification in patients presenting with acute coronary syndromes: insights from the MATRIX trial

Published:2023-10-09 Issue:11 Volume:12 Page:782-791
ISSN:2048-8726
Container-title:European Heart Journal: Acute Cardiovascular Care
language:en
Short-container-title:

Author:

Sanz-Sanchez Jorge¹²,Garcia-Garcia Hector M³^ORCID,Branca Mattia⁴,Frigoli Enrico⁴,Leonardi Sergio⁵,Gagnor Andrea⁶,Calabrò Paolo⁷⁸,Garducci Stefano⁹,Rubartelli Paolo¹⁰,Briguori Carlo¹¹,Andò Giuseppe¹²,Repetto Alessandra⁵,Limbruno Ugo¹³,Garbo Roberto¹⁴,Sganzerla Paolo¹⁵^ORCID,Russo Filippo¹⁶,Lupi Alessandro¹⁷,Cortese Bernardo¹⁸,Ausiello Arturo¹⁹,Ierna Salvatore²⁰,Esposito Giovanni²¹^ORCID,Santarelli Andrea²²,Sardella Gennaro²³,Varbella Fernando²⁴,Tresoldi Simone²⁵,de Cesare Nicoletta²⁶,Rigattieri Stefano²⁷,Zingarelli Antonio²⁸,Tosi Paolo²⁹,van ‘t Hof Arnoud³⁰,Boccuzzi Giacomo¹⁴,Omerovic Elmir³¹,Sabaté Manel³²,Heg Dik⁴^ORCID,Vranckx Pascal³³^ORCID,Valgimigli Marco³⁴

Affiliation:

1. Cardiology Department, Hospital Universitari i Politecnic La Fe , Valencia , Spain

2. Centro de Investigación Biomedica en Red (CIBERCV) , Madrid , Spain

3. Interventional Cardiology, MedStar Washington Hospital Center , 10 Irving St NW, Washington, DC 2001 , USA

4. CTU Bern, University of Bern , Bern , Switzerland

5. Coronary Care Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo , Pavia , Italy

6. Department of Invasive Cardiology, Maria Vittoria Hospital , Turin , Italy

7. Division of Cardiology, ‘Sant’Anna e San Sebastiano’ Hospital , Caserta , Italy

8. Department of Translational Medicine, University of Campania ‘Luigi Vanvitelli’ , Caserta , Italy

9. Cardiology Department, A.O. Ospedale Civile di Vimercate , Vimercate , Italy

10. Department of Cardiology, ASL3 Ospedale Villa Scassi , Genoa , Italy

11. Cardiology Department, Clinica Mediterranea , Naples , Italy

12. Azienda Ospedaliera Universitaria Policlinico ‘Gaetano Martino’, University of Messina , Messina , Italy

13. UO Cardiologia, ASL 9 Grosseto , Grosseto , Italy

14. Maria Pia Hsopital, GVM Care & Research , Turin , Italy

15. Cardiology Department, AO Ospedale Treviglio-Caravaggio , Treviglio , Italy

16. Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy

17. Division of Cardiology, ASL VCO , Verbania , Italy

18. Cardiology Department, Ospedale FatebeneFratelli , Milano , Italy

19. Cardiology Department, Casa di Cura Villa Verde , Taranto , Italy

20. Cardiology Department, Ospedale Sirai, Carbonia , Carbonia , Italy

21. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples , Naples , Italy

22. Cardiovascular Department, Infermi Hospital , Rimini , Italy

23. Policlinico Umberto I, ‘Sapienza’ University of Rome , Rome , Italy

24. Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3 , Turin , Italy

25. Cardiology Department, Azienda Ospedaliera Ospedale di Desio , Desio , Italy

26. Cardiology Department, Policlinico San Marco , Zingonia , Italy

27. Interventional Cardiology Unit, Sandro Pertini Hospital Rome, Rome, Italy

28. Cardiology Department, IRCCS Azienda Ospedaliera Universitaria San Martino , San Martino , Italy

29. Cardiology Department, Mater Salutis Hospital , Legnago, Italy

30. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , Netherlands

31. Cardiology Department, Ahlgrenska University Hospital , Göteborg , Sweden

32. Hospital Clinic, University of Barcelona, Thorax Institute, Department of Cardiology , Barcelona, Spain

33. Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis , Hasselt , Belgium

34. Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale , Via Tesserete 48, 6900 Lugano , Switzerland

Abstract

Abstract Aims The role of coronary calcification on clinical outcomes among different revascularization strategies in patients presenting with acute coronary syndromes (ACSs) has been rarely investigated. The aim of this investigation is to evaluate the role of coronary calcification, detected by coronary angiography, in the whole spectrum of patients presenting with acute ACS. Methods and results The present study was a post hoc analysis of the MATRIX programme. The primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause mortality, myocardial infarction (MI), or stroke up to 365 days. Among the 8404 patients randomized in the MATRIX trial, data about coronary calcification were available in 7446 (88.6%) and therefore were included in this post hoc analysis. Overall, 875 patients (11.7%) presented with severe coronary calcification, while 6571 patients (88.3%) did not present severe coronary calcification on coronary angiography. Fewer patients with severe coronary calcification underwent percutaneous coronary intervention whereas coronary artery bypass grafting or medical therapy-only was more frequent compared with patients without severe calcification. At 1-year follow-up, MACE occurred in 237 (27.1%) patients with severe calcified coronary lesions and 985 (15%) patients without severe coronary calcified lesions [hazard ratio (HR) 1.91; 95% confidence interval (CI) 1.66–2.20, P < 0.001]. All-cause mortality was 8.6% in patients presenting with and 3.7% in those without severe coronary calcification (HR 2.38, 1.84–3.09, P < 0.001). Patients with severe coronary calcification incurred higher rate of MI (20.1% vs. 11.5%, HR 1.81; 95% CI 1.53–2.1, P < 0.001) and similar rate of stroke (0.8% vs. 0.6%, HR 1.35; 95% CI 0.61–3.02, P = 0.46). Conclusion Patients with ACS and severe coronary calcification, as compared to those without, are associated with worse clinical outcomes irrespective of the management strategy.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,General Medicine

Link

https://academic.oup.com/ehjacc/advance-article-pdf/doi/10.1093/ehjacc/zuad122/52669144/zuad122.pdf

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