Nozoe Masatsugu, Nishioka Shinki, Oi Keiji, Suematsu Nobuhiro, Kubota Toru
Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital Fukuoka Japan.
Department of Clinical Engineering, Saiseikai Fukuoka General Hospital Fukuoka Japan.
Circ Rep. 2021 Nov 5;3(12):699-706. doi: 10.1253/circrep.CR-21-0129. eCollection 2021 Dec 10.
The presence of a calcified nodule (CN) is associated with unfavorable clinical outcomes after percutaneous coronary intervention (PCI). This study clarified the optimal management of CNs by reassessing the PCI strategy in association with patient background characteristics and clinical outcomes. Among 5,332 consecutive PCI cases managed using intra-coronary imaging, CNs were found in 167 lesions (3.1%). CNs were predominantly located at the proximal or mid-right coronary artery (RCA; 62%). More than half presented clinically as acute coronary syndrome (ACS; 56%). All-cause mortality and the target lesion revascularization (TLR) rate at 1 year were 13% and 23%, respectively. Multivariate analysis revealed that hemodialysis, diabetes, and ACS were independent risk factors for all-cause death, whereas hemodialysis and RCA location were independent risk factors for TLR. Regarding the PCI strategy, not using rotational atherectomy (RA) was significantly associated with restenosis, whereas placing a drug-eluting stent (DES) was not. Both hemodialysis and RCA location were strong predictors of poor outcomes after PCI for CN. Because not using RA was significantly associated with restenosis, it may be better to use RA whenever possible.
钙化结节（CN）的存在与经皮冠状动脉介入治疗（PCI）后的不良临床结局相关。本研究通过结合患者背景特征和临床结局重新评估PCI策略，阐明了CN的最佳管理方法。在连续5332例使用冠状动脉内成像进行管理的PCI病例中，167个病变（3.1%）发现有CN。CN主要位于右冠状动脉（RCA）近端或中段（62%）。超过一半的患者临床上表现为急性冠状动脉综合征（ACS；56%）。1年时的全因死亡率和靶病变血运重建（TLR）率分别为13%和23%。多变量分析显示，血液透析、糖尿病和ACS是全因死亡的独立危险因素，而血液透析和RCA位置是TLR的独立危险因素。关于PCI策略，未使用旋磨术（RA）与再狭窄显著相关，而植入药物洗脱支架（DES）则不然。血液透析和RCA位置都是CN患者PCI后预后不良的强预测因素。由于未使用RA与再狭窄显著相关，因此尽可能使用RA可能更好。
