Optical coherence tomography factors for adverse events in patients with severe coronary calcification. (1st April 2023)

• Record Type: Journal Article
• Authors: Nagata, Takako; Minami, Yoshiyasu; Katsura, Aritomo; Asakura, Kiyoshi; Katamine, Masahiro; Muramatsu, Yusuke; Fujiyoshi, Kazuhiro; Kinoshita, Daisuke; Ako, Junya
• Is Part Of: International journal of cardiology. Volume 376(2023)
• Page Start: 28
• Page End: 34
• Publication Date: 2023-04-01
• Subjects: Drug-eluting stent -- Eruptive calcified nodule -- Percutaneous coronary intervention; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2023.02.027
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Severe coronary calcification is a factor for worse outcomes after percutaneous coronary intervention. Aims: To identify factors of pre- and post-stent optical coherence tomography (OCT) for device-oriented clinical endpoints (DoCE) in patients with severely calcified lesions requiring drug-eluting stent (DES) implantation. Methods: A total of 237 consecutive patients with stable coronary disease who underwent OCT imaging of severe coronary lesions were included. Lesions with a maximum calcium angle >180°, maximum calcium thickness > 0.5 mm, and calcium length > 5 mm were defined as having severe calcification. Results: The prevalence of eruptive calcified nodules (41% vs. 18%, p = 0.002) and medial dissection with calcified flaps (59% vs. 26%, p < 0.001) was significantly higher in patients with DoCE ( n = 34) than those without DoCE ( n = 203). Multivariate analyses demonstrated that the presence of a medial dissection with calcified flap within the DES-implanted segment was independently associated with a higher incidence of DoCE (odds ratio, 3.367; 95% confidence interval, 1.503–7.543; p = 0.003). The combined presence of eruptive calcified nodules and medial dissection with calcified flaps was associated with a higher incidence of DoCE ( p < 0.001) during a median of 756 days after DES implantation. Conclusions: OCT-defined severely calcified lesions with eruptive calcified nodules and medial dissection with calcified flaps were associated with a higher incidence of DoCE after DES implantation. Graphical abstract: Unlabelled Image Highlights: Eruptive calcified nodule is associated with worse outcomes after DES implantation. Medial dissection with calcified flap is a novel factor for worse outcomes. The assessment of severe calcification using OCT facilitates risk stratification.