PCI for eruptive calcified nodules: Drug-eluting stents, drug-coated balloons both linked to poor outcomes
Percutaneous coronary intervention (PCI) with either drug-eluting stents (DES) or drug-coated balloons (DCB) is associated with poor clinical outcomes when treating lesions with eruptive calcified nodules, according to new findings published in The American Journal of Cardiology.[1] The study’s authors emphasized that there is an unmet need for alternative treatment options.
“Eruptive calcified nodules represent a distinct and high-risk plaque morphology implicated in the pathogenesis of acute coronary syndrome,” wrote first author Masahiro Koide, MD, PhD, a cardiologist with Kyoto Second Red Cross Hospital in Japan, and colleagues. “While prior studies have reported poor clinical outcomes following PCI with DES or DCB for these lesions, comparative data evaluating the efficacy of DES versus DCB therapy remain unavailable.”
Koide et al. explored data from 41 DES patients and 27 DCB patients treated at the same facility. The mean patient age was 75.6 years old, 69% were men and the most common comorbidities were hypertension and chronic kidney disease.
There were no statistically significant differences between the patients in these two groups, but the rates of hemodialysis and insulin use were slightly higher for the DES patients. Also, lesion location was comparable for the two groups.
The median follow-up period was 2.1 years. Overall, the study’s primary endpoint—clinically driven target lesion revascularization (CD-TLR) and cardiac death—was comparable, even after using propensity score matching to account for any “potential confounding factors.” Looking closer at the data, DES patients were linked to CD-TLR rates of 17% after one year, 20% after two years and 22% after three years. DCB patients, meanwhile, were linked to CD-TLR rates of 11%, 19% and 19%, respectively.
Researchers did note that the DCB patients were more likely to experience cardiovascular events within the first 180 days of treatment.
“Although the development of DES has markedly improved PCI outcomes, multiple studies have shown that, even with adjunctive plaque modification devices such as rotational atherectomy, the treatment of calcified lesions continues to be associated with suboptimal long-term results,” the authors wrote.
With these poor outcomes in mind, Koide and colleagues emphasized that coronary artery bypass grafting “may be a more appropriate revascularization strategy.” In addition, the group wrote their findings “underscore the need for alternative therapeutic strategies.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.