The impact of clinical presentation on one-year major adverse cardiac events in patients with angiographically defined moderate to severe calcified coronary artery disease

OBJECTIVES: The authors aimed to investigate the impact of clinical presentation on 1-year major adverse cardiac events (MACE) in patients with angiographically defined moderate or severe calcified coronary artery disease. METHODS: The authors conducted a retrospective, single-center cohort study in patients with moderate to severe coronary calcification who underwent percutaneous coronary intervention (PCI) between June 2020 and July 2021 with either chronic coronary syndrome (CCS) or acute coronary syndrome (ACS). The primary endpoint was 1-year MACE, a composite of all-cause mortality, myocardial infarction (MI), and ischemia-driven revascularization. Cox proportional hazards regression was used. RESULTS: Seven hundred twenty-four patients were included: 420 patients with ACS and 304 patients with CCS. The median age was 72.0 years. There were relatively more men in the CCS cohort (76.0% vs 66.2%, P = .005). Procedure time was longer in the context of CCS (88 minutes [25th-75th percentile: 56-104] vs 78 minutes [66-121], P < .001). Application of atherectomy and lithotripsy was similar in both cohorts. No significant difference was observed in the cumulative incidence of MACE between the ACS (15.0%) and CCS (16.4%) groups (HR, 0.94; 95% CI, 0.65-1.36; P = .74). Secondary outcomes, such as all-cause mortality, MI, and ischemia-driven revascularization, did not result in statistical significance between the groups. CONCLUSIONS: The cumulative incidence of 1-year MACE and its composites did not show statistically significant difference between patients with moderate or severe calcification in the context of CCS or ACS. This suggests that the clinical presentation of patients with calcified coronary arteries does not significantly affect their outcomes.