Prognostic implications of severe coronary calcification in patients undergoing coronary artery bypass surgery: An analysis of the SYNTAX study

Christos V. Bourantas, Yao Jun Zhang, Scot Garg, Michael Mack, Keith D. Dawkins, Arie Pieter Kappetein, Friedrich W. Mohr, Antonio Colombo, David Holmes, Elisabeth Sta˚hle, Ted Feldman, Marie Claude Morice, Ton De Vries, Marie Angèle Morel, Patrick W. Serruys

Research output: Contribution to journalArticle

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Abstract

Objectives: To investigate the prognostic implications of the presence of severe lesion calcification in patients undergoing coronary artery bypass graft (CABG) operation. Background: There is robust evidence that lesion calcification is a predictor of worse prognosis in patients undergoing percutaneous coronary intervention; however, there is limited data about the prognostic implication of lesion calcium in patients treated with CABG. Methods: We retrospectively analyzed data from 1,545 patients who underwent CABG and were recruited in the SYNTAX study and CABG registry. Two experts reviewed the angiographic data and classified patients in two groups: those with severely calcified coronary arteries and those without severe lesion calcification. Clinical outcomes at 5-year follow-up were collected and compared in the two groups. Results: One out of three patients exhibited severe lesion calcification (n5588). Patients with calcified coronaries had an increased mortality at 5-year follow-up (17.1% vs. 9.9%, P < 0.001) and a higher event rate of death-myocardial infarction (MI) compared with those without (19.4% vs. 13.2%, P = 0.003), but there was no statistical significant difference between the two groups for major adverse cardiovascular events (MACE, 26.8% vs. 21.8%, P = 0.057). In multivariate Cox regression analysis severe lesion calcification was an independent predictor of an increased all-cause mortality (hazard ratio: 1.39, 95% confidence interval: 1.02-1.89; P = 0.037) but it was not an independent predictor of the combined end-points death-MI or MACE. Conclusions: Severe lesion calcification is associated with an increased mortality in patients undergoing CABG, but it is not an independent predictor of death-MI or MACE. This paradox can be attributed to the fact that CABG allows perfusion of the healthy coronaries bypassing the diseased arteries and thus it minimizes the risk of coronary events due to progressive atherosclerosis.

Original languageEnglish (US)
Pages (from-to)199-206
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number2
DOIs
StatePublished - Feb 1 2015

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Coronary Artery Bypass
Transplants
Mortality
Myocardial Infarction
Percutaneous Coronary Intervention
Registries
Coronary Artery Disease
Atherosclerosis
Coronary Vessels
Perfusion
Regression Analysis
Confidence Intervals
Calcium

Keywords

  • Clinical outcomes
  • Coronary artery disease
  • Revascularization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic implications of severe coronary calcification in patients undergoing coronary artery bypass surgery : An analysis of the SYNTAX study. / Bourantas, Christos V.; Zhang, Yao Jun; Garg, Scot; Mack, Michael; Dawkins, Keith D.; Kappetein, Arie Pieter; Mohr, Friedrich W.; Colombo, Antonio; Holmes, David; Sta˚hle, Elisabeth; Feldman, Ted; Morice, Marie Claude; De Vries, Ton; Morel, Marie Angèle; Serruys, Patrick W.

In: Catheterization and Cardiovascular Interventions, Vol. 85, No. 2, 01.02.2015, p. 199-206.

Research output: Contribution to journalArticle

Bourantas, CV, Zhang, YJ, Garg, S, Mack, M, Dawkins, KD, Kappetein, AP, Mohr, FW, Colombo, A, Holmes, D, Sta˚hle, E, Feldman, T, Morice, MC, De Vries, T, Morel, MA & Serruys, PW 2015, 'Prognostic implications of severe coronary calcification in patients undergoing coronary artery bypass surgery: An analysis of the SYNTAX study', Catheterization and Cardiovascular Interventions, vol. 85, no. 2, pp. 199-206. https://doi.org/10.1002/ccd.25545
Bourantas, Christos V. ; Zhang, Yao Jun ; Garg, Scot ; Mack, Michael ; Dawkins, Keith D. ; Kappetein, Arie Pieter ; Mohr, Friedrich W. ; Colombo, Antonio ; Holmes, David ; Sta˚hle, Elisabeth ; Feldman, Ted ; Morice, Marie Claude ; De Vries, Ton ; Morel, Marie Angèle ; Serruys, Patrick W. / Prognostic implications of severe coronary calcification in patients undergoing coronary artery bypass surgery : An analysis of the SYNTAX study. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 85, No. 2. pp. 199-206.
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abstract = "Objectives: To investigate the prognostic implications of the presence of severe lesion calcification in patients undergoing coronary artery bypass graft (CABG) operation. Background: There is robust evidence that lesion calcification is a predictor of worse prognosis in patients undergoing percutaneous coronary intervention; however, there is limited data about the prognostic implication of lesion calcium in patients treated with CABG. Methods: We retrospectively analyzed data from 1,545 patients who underwent CABG and were recruited in the SYNTAX study and CABG registry. Two experts reviewed the angiographic data and classified patients in two groups: those with severely calcified coronary arteries and those without severe lesion calcification. Clinical outcomes at 5-year follow-up were collected and compared in the two groups. Results: One out of three patients exhibited severe lesion calcification (n5588). Patients with calcified coronaries had an increased mortality at 5-year follow-up (17.1{\%} vs. 9.9{\%}, P < 0.001) and a higher event rate of death-myocardial infarction (MI) compared with those without (19.4{\%} vs. 13.2{\%}, P = 0.003), but there was no statistical significant difference between the two groups for major adverse cardiovascular events (MACE, 26.8{\%} vs. 21.8{\%}, P = 0.057). In multivariate Cox regression analysis severe lesion calcification was an independent predictor of an increased all-cause mortality (hazard ratio: 1.39, 95{\%} confidence interval: 1.02-1.89; P = 0.037) but it was not an independent predictor of the combined end-points death-MI or MACE. Conclusions: Severe lesion calcification is associated with an increased mortality in patients undergoing CABG, but it is not an independent predictor of death-MI or MACE. This paradox can be attributed to the fact that CABG allows perfusion of the healthy coronaries bypassing the diseased arteries and thus it minimizes the risk of coronary events due to progressive atherosclerosis.",
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AU - Bourantas, Christos V.

AU - Zhang, Yao Jun

AU - Garg, Scot

AU - Mack, Michael

AU - Dawkins, Keith D.

AU - Kappetein, Arie Pieter

AU - Mohr, Friedrich W.

AU - Colombo, Antonio

AU - Holmes, David

AU - Sta˚hle, Elisabeth

AU - Feldman, Ted

AU - Morice, Marie Claude

AU - De Vries, Ton

AU - Morel, Marie Angèle

AU - Serruys, Patrick W.

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N2 - Objectives: To investigate the prognostic implications of the presence of severe lesion calcification in patients undergoing coronary artery bypass graft (CABG) operation. Background: There is robust evidence that lesion calcification is a predictor of worse prognosis in patients undergoing percutaneous coronary intervention; however, there is limited data about the prognostic implication of lesion calcium in patients treated with CABG. Methods: We retrospectively analyzed data from 1,545 patients who underwent CABG and were recruited in the SYNTAX study and CABG registry. Two experts reviewed the angiographic data and classified patients in two groups: those with severely calcified coronary arteries and those without severe lesion calcification. Clinical outcomes at 5-year follow-up were collected and compared in the two groups. Results: One out of three patients exhibited severe lesion calcification (n5588). Patients with calcified coronaries had an increased mortality at 5-year follow-up (17.1% vs. 9.9%, P < 0.001) and a higher event rate of death-myocardial infarction (MI) compared with those without (19.4% vs. 13.2%, P = 0.003), but there was no statistical significant difference between the two groups for major adverse cardiovascular events (MACE, 26.8% vs. 21.8%, P = 0.057). In multivariate Cox regression analysis severe lesion calcification was an independent predictor of an increased all-cause mortality (hazard ratio: 1.39, 95% confidence interval: 1.02-1.89; P = 0.037) but it was not an independent predictor of the combined end-points death-MI or MACE. Conclusions: Severe lesion calcification is associated with an increased mortality in patients undergoing CABG, but it is not an independent predictor of death-MI or MACE. This paradox can be attributed to the fact that CABG allows perfusion of the healthy coronaries bypassing the diseased arteries and thus it minimizes the risk of coronary events due to progressive atherosclerosis.

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KW - Revascularization

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