Prognostic Impact of Calcified Plaque Morphology After Drug Eluting Stent Implantation　― An Optical Coherence Tomography Study ―

Abstract

Background: Optical coherence tomography (OCT) has the potential to characterize the detailed morphology of calcified coronary plaques. This study examined the prognostic impact of calcified plaque morphology in patients with coronary artery calcification (CAC) who underwent newer-generation drug-eluting stent (DES) implantation. Methods and Results:In all, 251 patients with moderate to severe CAC who underwent OCT-guided DES implantation were reviewed retrospectively and divided into 3 groups according to OCT findings of the target lesion: 25 patients (10.0%) with calcified nodules (CN), 69 patients (27.5%) with calcified protrusion (CP) without CN, and 157 patients (62.5%) with superficial calcific sheet (SC) without CN and CP. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). Kaplan-Meier survival analysis revealed that, among the 3 groups, the rates of MACE-free survival (log-rank test, P=0.0117), myocardial infarction (log-rank test, P=0.0103), and TLR (log-rank test, P=0.0455) were significantly worse in patients with CN. Multivariate Cox proportional hazards analysis demonstrated that CN was an independent predictor of MACE (hazard ratio 4.41; 95% confidence interval 1.63-10.8; P=0.0047). Conclusions:Target lesion CN was associated with higher cardiac event rates in patients who underwent newer-generation DES implantation for lesions with moderate to severe CAC.

Effects of Patient Background and Treatment Strategy on Clinical Outcomes After Coronary Intervention for Calcified Nodule Lesions

“…Percutaneous coronary intervention (PCI) for CNs remains challenging, even in the contemporary drug-eluting stent (DES) era. 5 , 6 Kobayashi et al reported that the clinical outcomes of ACS with CNs were poor, with a higher incidence of target lesion revascularization (TLR) than in cases of plaque rupture or plaque erosion (27.1% vs. 10.7% and 5.2%, respectively). 7 Morofuji et al reported that the TLR rate was higher in the CN than non-CN group (23.2% vs. 7.9%) in cases with heavily calcified lesions treated with rotational atherectomy (RA) and second-generation DES (CNs observed in 48.5%).…”

Prediction of optical coherence tomography-detected calcified nodules using coronary computed tomography angiography

“…Recent intravascular imaging studies have shown the association between calci ed lesions with CNs and higher stent failure rates in patients who underwent newer-generation DES and modern devices [4,5,27]. Moreover, Prati et al reported that the presence of CNs in non-culprit coronary plaques was associated with worse clinical outcomes, including cardiac death and target-vessel MI [26].…”

“…Calci ed nodules (CNs), which are protrusions into the blood vessel lumens, are pathologically associated with acute coronary syndrome (ACS) [1][2][3] and other major cardiovascular events, such as target lesion revascularization, stent thrombosis, and myocardial infarction (MI) after percutaneous coronary intervention (PCI) [4,5]. The diagnosis of CNs is critical in proper management of patients with coronary artery disease.…”

Calcified Plaques in the Human Coronary Artery ― Each Calcified Plaque Is Never the Same ―

“…Because the nodules are surrounded by fibrin with platelet-rich white thrombus on top, DES is likely insufficient to protect against restenosis in this type of lesion. Thus, their data 7 showing a higher incidence of TLR in CN lesions make sense. Delayed reendothelialization seen after DES implantation may enhance additional thrombus attachment at the site of the original CN segment, resulting in in-stent restenosis or stent thrombosis.…”