Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan.
Catheter Cardiovasc Interv. 2021 Jan 1;97(1):10-19. doi: 10.1002/ccd.28896. Epub 2020 Apr 7.
We sought to evaluate the incidence and clinical impact of calcified nodule (CN) in patients with heavily calcified lesions requiring rotational atherectomy (RA).
It remains unclear whether CN impacts adversely on clinical outcomes in patients with heavily calcified lesions.
Between January 2011 and February 2014, 264 patients after second-generation drug-eluting stent (DES) implantation following RA were retrospectively enrolled. CN was defined as a convex shape of the luminal side of calcium as assessed by intravascular ultrasound. The primary endpoint was the cumulative 5-year incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, clinically driven target lesion revascularization (CDTLR), and definite stent thrombosis (ST).
CN was observed in 128 patients (48.5%) with heavily calcified lesions. Cumulative 5-year incidence of MACE was significantly higher in the CN group than in the non-CN group, mainly driven by a higher rate of CDTLR and ST (35.4% vs. 18.8%, p < .001; 23.2% vs. 7.9%, p < .001; 7.0% vs. 0.93%, p = .009, respectively). Independent risk factors of 5-year MACE included hemodialysis (hazard ratio [HR] = 3.39, 95% confidence intervals [CI]: 2.00-5.73, p < .001), CN (HR = 2.53, 95% CI: 1.49-4.27, p < .001), ostial lesion (HR = 3.02, 95% CI: 1.58-5.78, p = .001), left ventricular ejection fraction ≤40% (HR = 2.17, 95% CI: 1.27-3.70, p = .005), and right coronary artery lesion (HR = 1.82, 95% CI: 1.07-3.11, p = .03).
CN was observed in 48.5% of heavily calcified lesions, resulting in unfavorable long-term clinical outcomes after second-generation DES implantation following RA.
我们旨在评估需要旋磨术（RA）的重度钙化病变患者中钙化结节（CN）的发生率及其对临床结局的影响。
CN 是否会对重度钙化病变患者的临床结局产生不利影响，目前尚不清楚。
回顾性纳入 2011 年 1 月至 2014 年 2 月间 264 例行第二代药物洗脱支架（DES）置入后 RA 治疗的患者。CN 定义为血管内超声评估的钙内侧管腔的凸形。主要终点为主要不良心脏事件（MACE）的 5 年累积发生率，定义为心脏死亡、临床驱动的靶病变血运重建（CDTLR）和明确的支架血栓形成（ST）的复合终点。
在 128 例（48.5%）重度钙化病变患者中观察到 CN。CN 组的 5 年 MACE 发生率明显高于非 CN 组，主要归因于更高的 CDTLR 和 ST 发生率（35.4%比 18.8%，p < 0.001；23.2%比 7.9%，p < 0.001；7.0%比 0.93%，p = 0.009）。5 年 MACE 的独立危险因素包括血液透析（HR = 3.39，95%CI：2.00-5.73，p < 0.001）、CN（HR = 2.53，95%CI：1.49-4.27，p < 0.001）、开口病变（HR = 3.02，95%CI：1.58-5.78，p = 0.001）、左心室射血分数≤40%（HR = 2.17，95%CI：1.27-3.70，p = 0.005）和右冠状动脉病变（HR = 1.82，95%CI：1.07-3.11，p = 0.03）。
CN 在 48.5%的重度钙化病变中被观察到，导致 RA 治疗后第二代 DES 置入后长期临床结局不佳。
