Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY 10022, USA.
Circulation. 2012 Jul 31;126(5):537-45. doi: 10.1161/CIRCULATIONAHA.111.055004. Epub 2012 Jun 28.
Pathological studies suggest that calcified coronary nodules are a rare cause of thrombotic events. The frequency, distribution, predictors, and outcomes of calcified nodules have never been described.
After successful stenting in 697 patients (167 female; median age, 58.1 years) with acute coronary syndromes, 3-vessel gray-scale and virtual histology intravascular ultrasound was performed in the proximal-mid segments of all 3 coronary arteries as part of a prospective, multicenter study. On the basis of recent histological validation, an independent core laboratory identified calcified nodules as distinct calcification with an irregular, protruding, and convex luminal surface. Patients were followed up for 3 years (median). Overall, 314 calcified nodules were detected in 250 of 1573 analyzable arteries (185 of 623 patients). Thus, the prevalence of calcified nodules was 17% per artery and 30% per patient. Two or more calcified nodules were detected in 48 coronary arteries (3%) in 76 patients (12%). The calcified nodules were located <40 mm from the ostium of the coronary artery in 85% of left anterior descending arteries and 86% of left circumflex arteries, whereas calcified nodules within the right coronary arteries were evenly and more distally distributed. Patients with calcified nodules were significantly older and had more plaque volume, more thick-cap fibroatheroma, but fewer nonculprit lesion major adverse events on follow-up.
Calcified nodules in untreated nonculprit coronary segments in patients with acute coronary syndromes were more prevalent than previously recognized. Although their distribution mirrored the origin of most thrombotic events, calcified nodules caused fewer major adverse events during 3 years of follow-up.
病理学研究表明，钙化性冠状动脉小结节是血栓形成事件的罕见原因。钙化结节的频率、分布、预测因素和结局从未被描述过。
在 697 例急性冠脉综合征患者（女性 167 例；中位年龄 58.1 岁）成功进行支架置入后，作为一项前瞻性、多中心研究的一部分，对所有 3 支冠状动脉的近中段进行了 3 血管灰阶和虚拟组织学血管内超声检查。根据最近的组织学验证，一个独立的核心实验室将钙化结节定义为具有不规则、突出和凸面管腔表面的独特钙化。患者接受了 3 年的随访（中位数）。总的来说，在 1573 个可分析的动脉中有 250 个动脉（623 个患者中的 250 个）检测到 314 个钙化结节。因此，钙化结节的发生率为每支动脉 17%，每位患者 30%。76 例患者（12%）的 48 支冠状动脉（3%）检测到两个或更多钙化结节。在 85%的左前降支和 86%的左回旋支中，钙化结节位于冠状动脉开口<40mm 处，而右冠状动脉中的钙化结节分布均匀且更远离开口。有钙化结节的患者年龄明显较大，斑块体积较大，厚帽纤维粥样瘤较多，但随访期间非罪犯病变的主要不良事件较少。
在急性冠脉综合征患者未经治疗的非罪犯冠状动脉节段中，钙化结节比以前认为的更为常见。尽管它们的分布反映了大多数血栓形成事件的起源，但在 3 年的随访期间，钙化结节导致的主要不良事件较少。
