Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan.
Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan.
Can J Cardiol. 2024 Nov;40(11):1998-2007. doi: 10.1016/j.cjca.2024.06.008. Epub 2024 Jun 14.
Percutaneous coronary intervention (PCI) for lesions with eruptive calcified nodules (CNs) is associated with worse outcomes compared with that for other calcified lesions. We aimed to clarify the relationship between eruptive CNs at index PCI, optical coherence tomography (OCT) findings at the 8-month follow-up, and clinical outcomes using serial OCT.
This retrospective observational study used data from a prospective, single-centre registry. We conducted consecutive PCI for calcified lesions requiring rotational atherectomy (RA) with OCT guidance. We categorized 51 patients (54 lesions) into those with (16 patients [16 lesions]) and without eruptive CNs (35 patients [38 lesions]).
Post-PCI, stent expansion was comparable between the 2 groups, and CN-like protrusion was found in 75% of lesions with eruptive CNs. Follow-up OCT at 8 months revealed in-stent CNs in 54% of treated eruptive CN lesions, whereas lesions without eruptive CNs lacked in-stent CNs. Multivariate linear regression analysis demonstrated that eruptive CN was associated with maximum neointimal tissue (NIT) thickness (regression coefficient 0.303; 95% confidence interval, 0.057-0.549; P = 0.02). Consequently, patients with eruptive CNs exhibited a higher clinically driven target lesion revascularization (TLR) rate than did those without at 1 year (31.3% vs 2.9%, P = 0.009) and 5 years (43.8% vs 11.4%, P = 0.02). TLR primarily occurred in lesions with maximum eruptive CN arc angles > 180°.
Following RA treatment with acceptable stent expansion, eruptive CNs before PCI correlated with greater NIT formation with in-stent CNs, resulting in a higher TLR rate, particularly in lesions with maximum eruptive CN arc angles exceeding 180°.
经皮冠状动脉介入治疗（PCI）治疗爆发性钙化结节（CN）病变的结果较其他钙化病变更差。我们旨在通过连续光学相干断层扫描（OCT）明确指数 PCI 时的爆发性 CN、8 个月随访时的 OCT 结果与临床结局之间的关系。
本回顾性观察性研究使用前瞻性单中心登记处的数据。我们对需要旋磨术（RA）的钙化病变进行连续 PCI，并采用 OCT 指导。我们将 51 例（54 个病灶）患者分为有（16 例[16 个病灶]）和无爆发性 CN（35 例[38 个病灶]）两组。
PCI 后两组支架扩张程度相当，有爆发性 CN 的病灶中 75%发现 CN 样突起。8 个月时的随访 OCT 显示，54%经治疗的爆发性 CN 病灶中有支架内 CN，而无爆发性 CN 的病灶中则无支架内 CN。多变量线性回归分析显示，爆发性 CN 与最大新生内膜组织（NIT）厚度相关（回归系数 0.303；95%置信区间 0.057-0.549；P=0.02）。因此，与无爆发性 CN 的患者相比，有爆发性 CN 的患者在 1 年（31.3%比 2.9%，P=0.009）和 5 年（43.8%比 11.4%，P=0.02）时临床驱动的靶病变血运重建（TLR）发生率更高。TLR 主要发生在最大爆发性 CN 弧角＞180°的病变中。
在接受可接受的支架扩张的 RA 治疗后，PCI 前的爆发性 CN 与支架内 NIT 形成更相关，导致 TLR 发生率更高，尤其是在最大爆发性 CN 弧角超过 180°的病变中。
