Nagata Takako, Minami Yoshiyasu, Katsura Aritomo, Asakura Kiyoshi, Katamine Masahiro, Muramatsu Yusuke, Fujiyoshi Kazuhiro, Kinoshita Daisuke, Ako Junya
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Int J Cardiol. 2023 Apr 1;376:28-34. doi: 10.1016/j.ijcard.2023.02.027. Epub 2023 Feb 15.
Severe coronary calcification is a factor for worse outcomes after percutaneous coronary intervention.
To identify factors of pre- and post-stent optical coherence tomography (OCT) for device-oriented clinical endpoints (DoCE) in patients with severely calcified lesions requiring drug-eluting stent (DES) implantation.
A total of 237 consecutive patients with stable coronary disease who underwent OCT imaging of severe coronary lesions were included. Lesions with a maximum calcium angle >180°, maximum calcium thickness > 0.5 mm, and calcium length > 5 mm were defined as having severe calcification.
The prevalence of eruptive calcified nodules (41% vs. 18%, p = 0.002) and medial dissection with calcified flaps (59% vs. 26%, p < 0.001) was significantly higher in patients with DoCE (n = 34) than those without DoCE (n = 203). Multivariate analyses demonstrated that the presence of a medial dissection with calcified flap within the DES-implanted segment was independently associated with a higher incidence of DoCE (odds ratio, 3.367; 95% confidence interval, 1.503-7.543; p = 0.003). The combined presence of eruptive calcified nodules and medial dissection with calcified flaps was associated with a higher incidence of DoCE (p < 0.001) during a median of 756 days after DES implantation.
OCT-defined severely calcified lesions with eruptive calcified nodules and medial dissection with calcified flaps were associated with a higher incidence of DoCE after DES implantation.
严重冠状动脉钙化是经皮冠状动脉介入治疗后预后较差的一个因素。
确定在需要植入药物洗脱支架（DES）的严重钙化病变患者中，支架植入前后光学相干断层扫描（OCT）用于以器械为导向的临床终点（DoCE）的相关因素。
纳入237例连续接受严重冠状动脉病变OCT成像的稳定型冠心病患者。最大钙化角度>180°、最大钙化厚度>0.5mm且钙化长度>5mm的病变被定义为存在严重钙化。
有DoCE的患者（n = 34）中，爆发性钙化结节（41% 对18%，p = 0.002）和伴有钙化瓣的中层剥离（59% 对26%，p < 0.001）的发生率显著高于无DoCE的患者（n = 203）。多变量分析表明，DES植入节段内伴有钙化瓣的中层剥离与DoCE的较高发生率独立相关（比值比，3.367；95%置信区间，1.503 - 7.543；p = 0.003）。在DES植入后的中位756天期间，爆发性钙化结节和伴有钙化瓣的中层剥离同时存在与DoCE的较高发生率相关（p < 0.001）。
OCT定义的伴有爆发性钙化结节和伴有钙化瓣的中层剥离的严重钙化病变与DES植入后DoCE的较高发生率相关。
