WHAT IS KNOWN? CNs have a unique morphology and the potential to develop coronary events. Pathologically, CNs have been classified into 2 types: eruptive CNs and noneruptive CNs. In addition, recent studies
New Research PaperCoronaryImpact of Eruptive vs Noneruptive Calcified Nodule Morphology on Acute and Long-Term Outcomes After Stenting
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Section snippets
Study population
This was a single-center, retrospective, observational study. Consecutive patients who underwent OCT-guided PCI at St. Francis Hospital from 2012 to 2021 were screened (Supplemental Figure 1) to identify the presence of a de novo native coronary artery eruptive CN or a noneruptive CN on the pre-PCI OCT image in patients with evaluable pre- and post-PCI OCT and ≥6-month clinical follow-up. The study complied with the Declaration of Helsinki, the Institutional Review Board at St. Francis Hospital
Results
From 2012 to 2021, there were 3,981 vessels in 3,231 patients who underwent OCT-guided PCI in a de novo native coronary artery lesion with evaluable pre- and post-PCI OCT images; among them, there were 284 CNs in 240 lesions in 236 vessels from 236 patients (Supplemental Figure 1). Thus, the prevalence of a CN was 5.9% (236/3981) per vessel and 7.3% (236/3231) per patient. After eliminating 6 vessels in 6 patients without a 6-month follow-up and 4 secondary lesions (only the most severe lesion
Discussion
The main findings of the present study of CN lesions were as follows: 1) stent implantation deformed an eruptive CN more readily than a noneruptive CN; 2) the type of CN, negative remodeling, greater CN circumference, and greater surrounding calcium arc were independently associated with poor stent expansion; 3) TLR dramatically increased at approximately 6 months post-PCI in the eruptive CN group compared with the noneruptive CN group; and 4) an eruptive CN, greater CN circumference, greater Δ
Conclusions
Eruptive CNs and noneruptive CNs are distinctly different lesion morphologies, with a large eruptive CN with a greater hinge motion having worse outcomes after PCI despite better stent expansion. The mechanism was angiographic evidence of reprotrusion of the eruptive CN through stent struts.
Funding Support and Author Disclosures
Dr Evan Shlofmitz has been a consultant to Abbott Vascular, Medtronic, and Opsens Medical. Dr Khalique has received speaker fees from Edwards Lifesciences. Dr Cohen has received research grant support from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic and has received a consulting income from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Mintz has received honoraria from Boston Scientific/Philips. Dr Richard A. Shlofmitz has been a speaker for Shockwave
References (36)
- et al.
Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents
Int J Cardiol
(2017) - et al.
Coronary artery calcification: pathogenesis and prognostic implications
J Am Coll Cardiol
(2014) - et al.
High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial
J Am Coll Cardiol Intv
(2013) - et al.
Eruptive calcified nodules as a potential mechanism of acute coronary thrombosis and sudden death
J Am Coll Cardiol
(2021) - et al.
Cardiac outcomes in patients with acute coronary syndrome attributable to calcified nodule
Atherosclerosis
(2021) - et al.
Recognition of recurrent stent failure due to calcified nodule: between a rock and a hard place
J Am Coll Cardiol Case Rep
(2020) - et al.
Prevalence, predictors, and clinical presentation of a calcified nodule as assessed by optical coherence tomography
J Am Coll Cardiol Img
(2017) - et al.
In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography
J Am Coll Cardiol
(2013) - et al.
Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the international working group for intravascular optical coherence tomography standardization and validation
J Am Coll Cardiol
(2012) - et al.
Stent expansion indexes to predict clinical outcomes: an IVUS substudy from ADAPT-DES
J Am Coll Cardiol Intv
(2021)
Superficial calcium fracture after PCI as assessed by OCT
J Am Coll Cardiol Img
Coronary restenosis of in-stent protruding bump with rapid progression: optical frequency domain imaging and angioscopic observation
J Cardiol Cases
Clinical impact of OCT findings during PCI: the CLI-OPCI II study
J Am Coll Cardiol Img
High-speed rotational atherectomy versus modified balloons prior to drug-eluting stent implantation in severely calcified coronary lesions
Circ Cardiovasc Interv
Has our understanding of calcification in human coronary atherosclerosis progressed?
Arterioscler Thromb Vasc Biol
Histopathological validation of optical frequency domain imaging to quantify various types of coronary calcifications
Eur Heart J Cardiovasc Imaging
Pathophysiology of native coronary, vein graft, and in-stent atherosclerosis
Nat Rev Cardiol
Features and outcomes of patients with calcified nodules at culprit lesions of acute coronary syndrome: an optical coherence tomography study
Cardiology
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