Coronary Calcification In Patients Presenting With Acute Coronary Syndromes: Insights From The Matrix Trial.

OBJECTIVE The role of coronary calcification on clinical outcomes among different revascularization strategies in patients presenting with acute coronary syndromes (ACS) has been rarely investigated. The aim of this investigation is to evaluate the role of coronary calcification, detected by coronary angiography, in the whole spectrum of patients presenting with acute ACS. METHODS The present study was a post hoc analysis of the MATRIX program. The primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause mortality, myocardial infarction (MI), or stroke up to 365 days. RESULTS Among the 8,404 patients randomized in the MATRIX trial, data about coronary calcification was available in 7446 (88.6%) and therefore were included in this post-hoc analysis. Overall, 875 patients (11.7%) presented with severe coronary calcification, while 6,571 patients (88.3%) did not present severe coronary calcification on coronary angiography. Fewer patients with severe coronary calcification underwent percutaneous coronary intervention whereas coronary artery bypass grafting or medical therapy-only was more frequent compared with patients without severe calcification. At 1-year follow-up, MACE occurred in 237 (27.1%) patients with severe calcified coronary lesions and 985 (15%) patients without severe coronary calcified lesions [HR 1.91; 95% CI 1.66-2.20, p < 0.001]. All-cause mortality was 8.6% in patients presenting with and 3.7% in those without severe coronary calcification (HR 2.38, 1.84-3.09; p < 0.001). Patients with severe coronary calcification incurred higher rate of MI (20.1% vs 11.5%, HR 1.81; 95% CI 1.53-2.1, p < 0.001) and similar rate of stroke (0.8% vs 0.6%, HR 1.35; 95% CI 0.61-3.02, p = 0.46). CONCLUSIONS Patients with ACS and severe coronary calcification, as compared to those without, are associated with worse clinical outcomes irrespective of the management strategy