Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Her Majesty's Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Interv Cardiol. 2023 Jan 21;2023:6456695. doi: 10.1155/2023/6456695. eCollection 2023.
This study aimed to determine characteristics and pattern of a calcified nodule (CN) and/or nodular calcification (NC) detected by intravascular ultrasound (IVUS) on the device-oriented composite endpoint (DoCE) in patients with calcified lesions who underwent rotational atherectomy (RA)-assisted percutaneous coronary intervention (PCI).
The characteristics and pattern of a CN and/or NC on clinical outcome remain unknown.
We retrospectively enrolled patients who underwent RA-assisted PCI at Siriraj Hospital during August 2016 to April 2020. Preprocedural IVUS imaging was mandatory. CN/NC was defined as convex shape of luminal surface and luminal side of calcium with protrusion into the coronary artery lumen as assessed by IVUS. The primary outcome was cumulative of DoCE, defined as the composite of cardiovascular death, myocardial infarction, and clinically-driven target lesion revascularization.
Two hundred patients were included. Primary outcome occurred in 14%. The cumulative DoCE was significantly higher in the CN/NC group than that in the non-CN/NC group (20.7% vs. 8.8%, = 0.022). CN/NC ( = 0.023) and MSA ≤ 5.5 mm ( = 0.047) were correlated with a significantly higher cumulative DoCE. CN/NC was the independent predictor for the cumulative DoCE (HR = 2.96, 95% CI 1.08-8.11, = 0.035). Pattern and characteristic of CN/NC have a prognostic value. Patients with an eccentric CN/NC had a significantly higher cumulative DoCE compared to those CN/NC with concentric calcification ( = 0.014).
The presence of a CN/NC in patients with heavily calcified lesions who underwent RA-assisted PCI was found to be associated with increased cumulative 5 year DoCE, especially in patients with an eccentric CN/NC. The clinical trial is registered with TCTR20210616001.
本研究旨在确定接受旋磨辅助经皮冠状动脉介入治疗（RA-PCI）的钙化病变患者中，血管内超声（IVUS）检测到的钙化结节（CN）和/或结节钙化（NC）的特征和模式与基于器械的复合终点（DoCE）之间的关系。
CN 和/或 NC 的特征和模式与临床结局之间的关系尚不清楚。
我们回顾性纳入了 2016 年 8 月至 2020 年 4 月期间在 Siriraj 医院接受 RA-PCI 的患者。所有患者均接受了术前 IVUS 成像。CN/NC 定义为管腔表面和钙的管腔侧呈凸形，通过 IVUS 评估向冠状动脉管腔突出。主要结局是累积 DoCE，定义为心血管死亡、心肌梗死和临床驱动的靶病变血运重建的复合终点。
共纳入 200 例患者。主要结局事件的发生率为 14%。CN/NC 组的累积 DoCE 明显高于非 CN/NC 组（20.7%比 8.8%， = 0.022）。CN/NC（ = 0.023）和最小支架面积（MSA）≤5.5mm（ = 0.047）与更高的累积 DoCE 显著相关。CN/NC 是累积 DoCE 的独立预测因素（HR=2.96，95%CI 1.08-8.11， = 0.035）。CN/NC 的特征和模式具有预后价值。与同心性钙化相比，偏心性 CN/NC 患者的累积 DoCE 明显更高（ = 0.014）。
在接受 RA-PCI 的重度钙化病变患者中，存在 CN/NC 与 5 年累积 DoCE 增加相关，尤其是存在偏心性 CN/NC 的患者。该临床试验已在 TCTR 注册，注册号为 TCTR20210616001。
