Director of Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Director of The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Rd., Harbin, 150086, China.
Cardiovascular Research Foundation, New York, NY, USA.
BMC Cardiovasc Disord. 2022 Mar 14;22(1):103. doi: 10.1186/s12872-022-02551-7.
Calcified plaque is thought to adversely impact outcomes after percutaneous coronary intervention (PCI). This study sought to evaluate the impact of nodular calcification in patients with acute coronary syndrome treated with primary percutaneous coronary intervention.
Using optical coherence tomography (OCT), 500 culprit plaques with calcification were analyzed from 495 acute coronary syndrome (ACS) patients on whom PCI was performed. Based on morphology, we classified calcification into two subtypes: nodular calcification and non-nodular calcification. Nodular calcification was defined as protruding mass with an irregular surface, high backscattering, and signal attenuation while non-nodular calcification was defined as an area with low backscattering heterogeneous region with a well-delineated border without protrusion into the lumen on OCT.
Calcified culprit plaques were divided into nodular calcification group (n = 238) and non-nodular calcification group (n = 262). Patients with nodular calcification were older (p < 0.001) and had lower left ventricular ejection fraction (p = 0.006) compared to patients with non-nodular calcification. Minimum stent area (5.0 (3.9, 6.3) mm vs. 5.4 (4.2, 6.7) mm, p = 0.011) and stent expansion (70 (62.7, 81.8) % vs. 75 (65.2, 86.6) %, p = 0.004) were significantly smaller in the nodular calcification group than in the non-nodular calcification group. Stent under-expansion was most frequent (p = 0.003) in the nodular calcification group.
This study demonstrate that the presence of nodular calcification is associated with a smaller minimum stent area and a higher incidence of stent under-expansion. Lesions with nodular calcification may be at risk of stent under-expansion.
人们认为，经皮冠状动脉介入治疗（PCI）后钙化斑块会对预后产生不利影响。本研究旨在评估在接受直接经皮冠状动脉介入治疗的急性冠状动脉综合征（ACS）患者中，结节状钙化的影响。
对 495 例接受 PCI 的 ACS 患者的 500 个有钙化的罪犯斑块进行光学相干断层扫描（OCT）分析。根据形态学，我们将钙化分为两种亚型：结节状钙化和非结节状钙化。结节状钙化定义为具有不规则表面、高反向散射和信号衰减的突出肿块，而非结节状钙化定义为 OCT 上边界清晰、无突出进入管腔的低反向散射异质区域。
钙化罪犯斑块分为结节状钙化组（n=238）和非结节状钙化组（n=262）。与非结节状钙化组相比，结节状钙化组患者年龄较大（p<0.001），左心室射血分数较低（p=0.006）。结节状钙化组最小支架面积（5.0[3.9,6.3]mm 比 5.4[4.2,6.7]mm，p=0.011）和支架扩张率（70[62.7,81.8]%比 75[65.2,86.6]%，p=0.004）明显较小。结节状钙化组支架扩张不足发生率最高（p=0.003）。
本研究表明，存在结节状钙化与最小支架面积较小和支架扩张不足发生率较高相关。具有结节状钙化的病变可能存在支架扩张不足的风险。
