Wu Xi, Wu Mingxing, Huang Haobo, Wang Lei, Liu Zhe, Cai Jie, Huang He
Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China.
Rev Cardiovasc Med. 2024 Apr 7;25(4):136. doi: 10.31083/j.rcm2504136. eCollection 2024 Apr.
Calcified nodules (CN) have been linked to unfavorable clinical outcomes. However, there is a lack of systematic studies on non-culprit lesions with CN in patients with acute coronary syndromes (ACS). This study aims to investigate the frequency, distribution, predictors, and outcomes of CN in non-culprit lesions among ACS patients.
We included 376 ACS patients who received successful stent placement in their culprit lesions. Intravascular ultrasound (IVUS) was performed to evaluate non-culprit lesions in left main arteries and all three coronary arteries (CA). CN was defined as accumulations of small nodular calcium deposits exhibiting a convex shape protruding into the lumen.
CNs was identified in 16.9% (121 of 712) per artery and 26.9% (101 of 376) per patient. They were predominantly located at the mid portion of the right coronary artery (26.3%) and the bifurcation site (59.9%). Patients with CN were older (63.57 8.43 vs. 57.98 7.15, 0.001) and had a higher prevalence of diabetes mellitus (55.4% vs. 42.2%, = 0.022). However, there were no significant differences in baseline characteristics observed after propensity score matching (PSM). Multivariate analysis revealed that CN were independently associated with major adverse cardiovascular events (MACE) both before and after PSM (hazard ratio (HR): 0.341, 95% confidence interval (95% CI): 0.140-0.829, = 0.018; HR: 0.275, 95% CI: 0.108-0.703, = 0.007, respectively). During the observational period of 19.35 10.59 months, the occurrence of MACE was significantly lower in patients with CN before and after PSM (5.9% vs. 16.7%, = 0.046; 4.0% vs. 18.1%, = 0.011; respectively).
CN in non-culprit lesions with ACS patients was prevalent and caused fewer adverse clinical outcomes.
钙化结节（CN）与不良临床结局相关。然而，对于急性冠状动脉综合征（ACS）患者中非罪犯病变合并CN的情况，缺乏系统性研究。本研究旨在调查ACS患者中非罪犯病变中CN的发生率、分布、预测因素及结局。
我们纳入了376例在罪犯病变成功置入支架的ACS患者。采用血管内超声（IVUS）评估左主干及所有三支冠状动脉（CA）的非罪犯病变。CN定义为向管腔内突出呈凸形的小结节状钙沉积聚集。
每支动脉中CN的检出率为16.9%（712支动脉中的121支），每位患者的检出率为26.9%（376例患者中的101例）。它们主要位于右冠状动脉的中段（26.3%）和分叉部位（59.9%）。合并CN的患者年龄更大（63.57±8.43岁 vs. 57.98±7.15岁，P<0.001），糖尿病患病率更高（55.4% vs. 42.2%，P = 0.022）。然而，倾向评分匹配（PSM）后观察到的基线特征无显著差异。多因素分析显示，PSM前后CN均与主要不良心血管事件（MACE）独立相关（风险比（HR）：0.341，95%置信区间（95%CI）：0.140 - 0.829，P = 0.018；HR：0.275，95%CI：0.108 - 0.703，P = 0.007）。在19.35±10.59个月的观察期内，PSM前后合并CN的患者MACE发生率显著更低（分别为5.9% vs. 16.7%，P = 0.046；4.0% vs. 18.1%，P = 0.011）。
ACS患者非罪犯病变中的CN很常见，且导致的不良临床结局较少。
