Calcium: A predictor of interventional treatment failure across all fields of cardiovascular medicine

In this substudy of the ADAPT-DES trial Généreux et al. compared two years outcomes according to the presence or absence of coronary artery calcification (CAC) as assessed by coronary angiography. Coronary calcification was an independent predictor of interventional treatment failure and a higher incidence of both ischemic events and bleeding. The cohort with CAC was older with a higher prevalence of risk factors and comorbidities and an increased anatomical complexity of the target lesions, explaining only in part the worse outcome of the CAC population that persisted at multivariate analysis. Incomplete expansion and poor stent apposition, more frequent in calcified lesions, are predictive of target lesion failure and late stent thrombosis. The main limitation of the study is the use of angiography for CAC assessment with a likely major underestimation of CAC burden. Intravascular imaging might also help for a more accurate quantification of the CAC burden and characteristics, selecting the lesions in need of a calcium modification with atherectomy or lithotripsy before stent implantation.