Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China; Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Cardiovascular Research Foundation, New York, NY, USA.
Int J Cardiol. 2017 Dec 1;248:97-102. doi: 10.1016/j.ijcard.2017.08.028. Epub 2017 Aug 12.
Increasing coronary lesion calcification is thought to be associated with adverse percutaneous coronary intervention (PCI) and clinical outcomes. We investigated the effects of calcium burden on culprit lesion morphology and clinical events after intravascular ultrasound (IVUS)-guided PCI in the ADAPT-DES study.
ADAPT-DES was a prospective, multicenter registry of 8582 consecutive patients undergoing successful PCI using DES. A pre-specified virtual histology (VH)-IVUS substudy of 638 culprit lesions (638 patients) had both pre- and post-PCI VH-IVUS. We divided lesions into tertiles according to pre-PCI percent dense calcium volume (DCV%=dense calcium/plaque volume×100).
Compared with low and intermediate DCV% tertiles, patients in the high DCV% tertile had the largest arc of superficial calcium, highest percentage of necrotic core volume, and smallest remodeling index; they were also more likely to have advanced lesion morphology such as attenuated plaque and VH thin-cap fibroatheromas. In the high DCV% tertile IVUS guidance was associated with a minimum stent area that was smaller than tertiles with less calcium (p=0.01), but acceptable range, and similar stent expansion (73.8±16.8% vs. 74.0±19.2% vs. 72.4±17.3%, p=0.62) after more frequent use of rotational atherectomy and higher maximum inflation pressure. There was no significant association between pre-PCI DCV% and 2-year target lesion revascularization or major adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis).
Increasing coronary artery calcification burden was associated with more advanced, complex VH-IVUS lesion morphology, but not with adverse clinical outcomes, perhaps due to more aggressive PCI techniques that optimized stent expansion.
越来越多的冠状动脉病变钙化被认为与经皮冠状动脉介入治疗（PCI）不良和临床结局相关。我们在 ADAPT-DES 研究中调查了血管内超声（IVUS）指导 PCI 后钙负荷对罪犯病变形态和临床事件的影响。
ADAPT-DES 是一项前瞻性、多中心注册研究，共纳入 8582 例成功接受 DES 治疗的 PCI 患者。根据预先设定的虚拟组织学（VH）-IVUS 亚组研究，对 638 个罪犯病变（638 例患者）进行了 PCI 前后的 VH-IVUS 检查。我们根据 PCI 前的致密钙体积百分比（DCV%=致密钙/斑块体积×100）将病变分为三分位。
与低和中 DCV%三分位相比，高 DCV%三分位患者的浅层钙弧最大，坏死核心体积百分比最高，重塑指数最小；他们也更有可能具有晚期病变形态，如衰减斑块和 VH 薄帽纤维粥样瘤。在高 DCV%三分位中，IVUS 指导与最小支架面积较小有关，该面积小于钙较少的三分位（p=0.01），但可接受范围相似，支架扩张也相似（73.8±16.8%比 74.0±19.2%比 72.4±17.3%，p=0.62），这与更频繁地使用旋磨术和更高的最大充气压力有关。PCI 前 DCV%与 2 年靶病变血运重建或主要不良心脏事件（心脏死亡、心肌梗死或支架血栓形成）之间没有显著关联。
冠状动脉钙化负担的增加与更先进、更复杂的 VH-IVUS 病变形态相关，但与不良临床结局无关，这可能是由于更积极的 PCI 技术优化了支架扩张。
