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

Abstract

Background: Little is known about intravascular imaging predictors of cardiac events after drug-eluting stent (DES) implantation in hemodialysis (HD) patients. We aimed to reveal the association between calcified nodules (CN) and target lesion failure (TLF) in HD patients after DES implantation.Methods: We enrolled 114 HD patients who underwent DES implantation between October 2016 and October 2020. The patients were divided into a CN group (39%, 44 patients) and a non-CN group (61%, 70 patients). The primary endpoint was the incidence of TLF, including cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization.Results: HD duration was longer, and the calcium burden was higher in the CN group than in the non-CN group. Over a median follow-up of 607 days [interquartile range: 349-965 days], the cumulative incidence curve showed that the CN group had a significantly higher incidence of TLF than the non-CN group (31.8% vs. 11.4% within 3 years, p = 0.008). On Fine-Gray sub-distribution hazard model analysis, the CN group was associated with an increased rate of TLF (hazard ratio [HR]: 2.86; 95% confidence interval [CI]: 1.21-6.75, p = 0.016). An in-stent CN was observed in 73% of the lesions with target lesion revascularization in the CN group, whereas no in-stent CN was observed in the non-CN group (p = 0.026).Conclusions: CN was an independent predictor of TLF in patients undergoing HD.In-stent CN was an important cause of TLF after DES implantation in CN lesions in HD patients; therefore, a different strategy should be considered for treating the lesions.

Calcified Nodules in Non-Culprit Lesions with Acute Coronary Syndrome Patients

“…More recently, CN was discovered to be the underlying morphology of heavily calcified lesions (CLs) in 48.5% (n = 128 out of 264) of patients with high-risk features who required rotational atherectomy [ 4 ]. Furthermore, among patients with long-standing hemodialysis and a high burden of calcium, the prevalence of CN was 26% (n = 44 out of 114), with eruptive CN occurring in 26% of all CN lesions [ 18 ]. Regarding the pathogenesis of ACS, Sugane et al .…”

Calcified coronary nodule: Tip of the iceberg on a road full of thorns

“…In this issue of Catheterization and Cardiovascular Interventions, Natsuhiro et al performed a retrospective review of 114 consecutive hemodialysis patients who underwent PCI with OCT evaluation. 5 Calcified nodules were present in 39% of hemodialysis patients, and occurred more frequently in patients with longer duration of hemodialysis. CN location was more commonly seen in the right coronary, lesions were more complex and required more atherectomy compared to lesions without CN.…”

“…Chronic kidney disease has consistently been associated with the presence of calcified coronary nodules, but little is known about the prevalence in patients with end‐stage renal failure on hemodialysis. In this issue of Catheterization and Cardiovascular Interventions, Natsuhiro et al performed a retrospective review of 114 consecutive hemodialysis patients who underwent PCI with OCT evaluation 5 . Calcified nodules were present in 39% of hemodialysis patients, and occurred more frequently in patients with longer duration of hemodialysis.…”