Impact of vessel calcification on outcomes after coronary stenting

Calcified coronary arteries have few viable smooth muscle cells capable of proliferating, and, subsequently, might exhibit less in-stent restenosis. We therefore studied the outcome of stenting in patients with different amounts of coronary calcification.

Six hundred twenty-one patients who underwent bare metal stenting of calcific native coronary arteries were studied retrospectively. Pre- and postinterventional intravascular ultrasound (IVUS) and qualitative and quantitative coronary angiography (QCA) were performed in 662 lesions. The arc of calcium was measured, and arteries were grouped (A, B, C, and D) according to the calcium arc in IVUS (0-90 degrees , 91-180 degrees , 181-270 degrees , and 271-360 degrees , respectively). Arteries with a superficial calcium arc of < or =270 degrees (Group E) were compared to arteries with >270 degrees calcification (Group F).

Clinical and lesion characteristics were similar, and the major complication rate was low (1.9%) in all groups. In Groups A, B, C, and D, patients with more calcific arteries had more non-Q-wave myocardial infarction (MI) (P=.04-.002). Patients in Group F (more extensive superficial calcification) had an increased frequency of non-Q-wave MI compared to Group E. Malapposition of stents to vessel wall and use of rotational atherectomy were more frequent in Group F (P=.001). Late events including death, MI, and revascularization with either coronary artery bypass grafting or percutaneous coronary intervention (PCI) were not different among the groups. Extensive calcification of coronary arteries is associated with more frequent peri-procedural non-Q-wave MI.

Despite the scarcity of viable cells, the late event rate in severely calcified arteries is not different from mildly calcified arteries. This may be due to more frequent malapposition of stents to vessel wall and augmented trauma during PCI in severely calcified arteries.