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

Abstract

Background: The presence of a calcified nodule (CN) is associated with unfavorable clinical outcomes after percutaneous coronary intervention (PCI). This study clarified the optimal management of CNs by reassessing the PCI strategy in association with patient background characteristics and clinical outcomes. Methods and Results: Among 5,332 consecutive PCI cases managed using intra-coronary imaging, CNs were found in 167 lesions (3.1%). CNs were predominantly located at the proximal or mid-right coronary artery (RCA; 62%). More than half presented clinically as acute coronary syndrome (ACS; 56%). All-cause mortality and the target lesion revascularization (TLR) rate at 1 year were 13% and 23%, respectively. Multivariate analysis revealed that hemodialysis, diabetes, and ACS were independent risk factors for all-cause death, whereas hemodialysis and RCA location were independent risk factors for TLR. Regarding the PCI strategy, not using rotational atherectomy (RA) was significantly associated with restenosis, whereas placing a drug-eluting stent (DES) was not. Conclusions: Both hemodialysis and RCA location were strong predictors of poor outcomes after PCI for CN. Because not using RA was significantly associated with restenosis, it may be better to use RA whenever possible.

Impact of calcified nodule on target lesion failure after stent implantation in hemodialysis patients

“…Our data also demonstrated that the lesion location differed between the CN and non‐CN groups. The CN is frequently located in the right coronary artery 5,11,23 . Again, our results are consistent with previous studies 5,11,23 …”

“…The CN is frequently located in the right coronary artery. 5,11,23 Again, our results are consistent with previous studies. 5,11,23…”

Characteristics of calcified nodule attributable to culprit lesion in acute coronary syndrome: A systematic review and meta-analysis

“… 24 Japan Case Control Retrospective Good N/A N/A 74 7 9.5 OCT 17 Nozoe et al. 25 Japan Cohort Retrospective Good 73.1 ± 10.2 120 5332 167 3.1 IVUS 18 Terada et al. 26 Japan Cohort Retrospective Good 80.0 (72.0–83.0) 11 156 15 9.6 OCT 19 Torii et al.…”

Predictors of Optical Coherence Tomography-Defined Calcified Nodules in Patients With Acute Coronary Syndrome ― A Substudy From the TACTICS Registry ―

“…The presence of OCT-CN is associated with a higher incidence of target lesion failure. 4,5,29 Appropriate lesion preparation, including the use of debulking devices, such as rotational atherectomy 30 and/or intravascular lithotripsy, 31 during PCI, may need to be considered. Because optimal stent expansion can be hampered by the presence of CN, stentless strategies, such as the combined use of rotational atherectomy and drug-coated balloon number of patients enrolled in the prospective multicenter registry.…”