title: Target lesion calcification and risk of adverse outcomes in patients with drug-eluting stents. A meta-analysis.
abstract: BACKGROUND
  Studies focusing on the relationship between calcified lesions and adverse outcomes in the drug-eluting stent (DES) era have presented inconsistent conclusions. The aim of this study was to assess the association between target lesion calcification and adverse outcomes in patients undergoing DES implantation.
  
  
  METHODS
  A systematic search was conducted on Medline (Ovid SP, 1946 to 28 February 2014), Embase (Ovid SP, 1974 to 28 February 2014), and the Chinese Biomedical Literature Database (CBM, 1978 to 28 February 2014). Abstracts from the 2012 and 2013 scientific meetings of the American College of Cardiology and American Heart Association were manually searched. Hazard ratios (HRs) were pooled using a fixed or random effects model in the context of heterogeneity.
  
  
  RESULTS
  A total of 13 studies comprising 66,361 patients were included. Target lesion calcification was associated with an increased risk of all-cause mortality (HR = 1.41; 95 % CI = 1.27-1.56), cardiac death (HR = 1.97; 95 % CI = 1.68-2.31), myocardial infarction (HR = 1.33; 95 % CI = 1.13-1.57), target lesion revascularization (TLR; HR 1.47, 95 % CI 1.18-1.83), stent thrombosis (HR 1.63, 95 % CI 1.36-1.96), and major cardiovascular events (HR 1.37, 95 % CI 1.19-1.58). The results proved robust in subgroup analyses for TLR and stent thrombosis.
  
  
  CONCLUSIONS
  Calcified target lesions are risk factors for adverse outcomes in the DES era. Further studies focusing on comprehensive therapy in patients with coronary calcification are urgently needed.
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Bao-Tao
authors.initials: BT
authors.lastname: Huang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Fang-Yang
authors.initials: FY
authors.lastname: Huang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Zhi-Liang
authors.initials: ZL
authors.lastname: Zuo
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Kai-Sen
authors.initials: KS
authors.lastname: Huang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Yan-Biao
authors.initials: YB
authors.lastname: Liao
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Peng-Ju
authors.initials: PJ
authors.lastname: Wang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Zhen-Gang
authors.initials: ZG
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: De-Jia
authors.initials: DJ
authors.lastname: Huang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China. hmaochen@vip.sina.com.
authors.forename: Mao
authors.initials: M
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000401:mortality* / Q000628:therapy*; D015984:Causality; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Coronary artery calcification; Drug-eluting stent; Outcome; Percutaneous coronary intervention; Risk factor