Cracking (The Code of) Coronary Artery Calcification Towin the Last Battle of Percutaneous Coronary Intervention

Still in the Middle of a Rocky Road

Norihiro Kogame; Patrick W. Serruys; Yoshinobu Onuma


Eur Heart J. 2020;41(6):797-800. 

In This Article

Does DAPT Need to be Modified in Calcified Lesions?

Another clinical question posed by this pathological study[10] is whether dual-antiplatelet therapy (DAPT) should be prolonged in patients with calcified lesion(s). Since a calcified lesion is associated with delayed healing and decreased endothelial coverage of the strut, theoretically it would be beneficial to prolong antiplatelet therapy to prevent stent thrombosis of the unhealed stented lesion. Currently 'lesion calcification' is not included in risk scoring that evaluates both bleeding and ischaemic risk (e.g. PRECISE-DAPT, PARIS, and DAPT score), but 'severe calcification' as a lesion-based parameter may need to be incorporated in such risk stratifications. The addition of 'severe calcification item' to the evaluation of the balance between ischaemic and bleeding risk may be important especially in populations with a high risk of bleeding.[19]

The pathological study by Torii et al. unravelled the poor healing process of calcified lesions after stent implantation and partially elucidated the underlying mechanism of a higher number of event rates after DES implantation in calcified lesion(s) when compared with non-calcified lesion(s). This new piece of histopathological evidence raised many additional clinical questions. We are still in the middle of a long and rocky road before we master the treatment of calcified lesion(s)—one of the last remaining challenges in coronary intervention.