title: Revascularization Strategies for Calcified Lesions in Patients Presenting With Acute Coronary Syndromes (From the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY] Trial).
abstract: BACKGROUND
  Revascularization of calcified coronary lesions has been shown to be associated with suboptimal outcomes. The optimal revascularization strategy for calcified lesions in patients presenting with non-ST segment elevation acute coronary syndromes (NSTEACS) has yet to be defined.
  
  
  METHODS
  Outcomes in patients presenting with NSTEACS and moderately or severely calcified target lesions in native coronary vessels, as assessed by an independent angiographic core lab, were examined according to revascularization strategy (percutaneous coronary intervention [PCI] vs coronary artery bypass graft [CABG] surgery) from the large-scale, prospective ACUITY trial. Propensity-adjusted multivariable analysis was used to identify the independent predictors of events at 30 days.
  
  
  RESULTS
  Of 1315 NSTEACS patients with moderately and severely calcified lesions in whom revascularization was performed, a total of 334 (25%) and 981 (75%) underwent CABG and PCI, respectively. CABG patients had more severe baseline comorbidities and coronary artery disease. By propensity-adjusted multivariable analysis, the CABG group had higher 30-day rates of reinfarction, composite death or reinfarction, major bleeding, and thrombocytopenia.
  
  
  CONCLUSIONS
  In this large-scale study of patients presenting for NSTEACS, 30-day adverse events were more frequent after revascularization of calcified coronary lesions with CABG rather than PCI. Further studies are warranted to evaluate means of improving early safety outcomes in this high-risk patient group with complex coronary disease.
authors.forename: Madhusudhan
authors.initials: M
authors.lastname: Tarigopula
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.forename: Mahesh V
authors.initials: MV
authors.lastname: Madhavan
authors.forename: Rupa
authors.initials: R
authors.lastname: Parvataneni
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Columbia University Medical Center, Cardiovascular Research Foundation, 111 E. 59th St., 11th Floor, New York, NY 10022 USA. gs2184@columbia.edu.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery