Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Catheter Cardiovasc Interv. 2021 Mar;97(4):634-645. doi: 10.1002/ccd.28847. Epub 2020 Mar 17.
To compare the postprocedural optical coherence tomography (OCT) findings and in-hospital outcomes among the three subtypes of calcified plaques: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion.
Recently, three subtypes of calcified culprit plaques were reported in patients with acute coronary syndrome (ACS). How these subtypes respond to stenting is unknown.
ACS patients with calcified plaque at the culprit lesion were selected from our database. OCT findings at baseline and after stent implantation were compared.
In the final analysis, 87 cases were included. Preprocedural OCT showed eruptive calcified nodules in 19 (21.8%) cases, superficial calcific sheet in 63 (72.4%), and calcified protrusion in 5 (5.7%). Stent edge dissection (SED) and incomplete stent apposition (ISA) were frequently observed in the eruptive calcified nodules group compared to superficial calcific sheet or calcified protrusion (SED; 47.4% vs. 17.5% vs. 20.0%; p = .032, ISA; 94.7% vs. 58.7% vs. 0.0%; p < .001). The superficial calcific sheet group had the smallest minimal stent area (MSA) among the three groups (eruptive calcified nodules vs. superficial calcific sheet vs. calcified protrusion: 6.29 ± 2.41 vs. 4.72 ± 1.37 vs. 6.56 ± 1.13; p = .007). The superficial calcific sheet group had a higher rate of periprocedural myocardial infarction compared to the eruptive calcified nodules group (60.3% vs. 31.6%; p = .028).
This study demonstrated eruptive calcified nodules are associated with higher incidence of SED and ISA, whereas superficial calcific sheets are associated with small MSA and higher periprocedural myocardial infarction.
比较三种钙化斑块亚型（爆发性钙化结节、浅表钙化层和钙化突起）的经皮冠状动脉介入治疗（PCI）后光学相干断层扫描（OCT）结果和住院结局。
最近，在急性冠脉综合征（ACS）患者中报告了三种钙化罪犯斑块亚型。尚不清楚这些亚型对支架置入的反应如何。
从我们的数据库中选择了有钙化斑块罪犯病变的 ACS 患者。比较了基线和支架置入后的 OCT 结果。
最终分析包括 87 例患者。术前 OCT 显示爆发性钙化结节 19 例（21.8%）、浅表钙化层 63 例（72.4%）和钙化突起 5 例（5.7%）。与浅表钙化层或钙化突起相比，爆发性钙化结节组支架边缘夹层（SED）和支架贴壁不良（ISA）更为常见（SED；47.4%比 17.5%比 20.0%；p =.032，ISA；94.7%比 58.7%比 0.0%；p < .001）。三组中最小支架面积（MSA）最小的是浅表钙化层（爆发性钙化结节比浅表钙化层比钙化突起：6.29 ± 2.41 比 4.72 ± 1.37 比 6.56 ± 1.13；p =.007）。与爆发性钙化结节组相比，浅表钙化层组围手术期心肌梗死发生率更高（60.3%比 31.6%；p =.028）。
本研究表明，爆发性钙化结节与较高的 SED 和 ISA 发生率相关，而浅表钙化层与较小的 MSA 和较高的围手术期心肌梗死发生率相关。
