Yasumura Keisuke, Koshy Anoop N, Vinayak Manish, Vengrenyuk Yuliya, Minatoguchi Shingo, Krishnamoorthy Parasuram, Hooda Amit, Sharma Raman, Kapur Vishal, Sweeny Joseph, Sharma Samin K, Kini Annapoorna S
Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Cardiology, Austin Health & the University of Melbourne, Melbourne, Victoria, Australia.
Catheter Cardiovasc Interv. 2024 Dec;104(7):1373-1386. doi: 10.1002/ccd.31246. Epub 2024 Oct 23.
The optimal treatment strategy for coronary calcified nodules (CN) remains uncertain. We aimed to evaluate the efficacy and safety of different calcium modification strategies, including rotational atherectomy (RA), orbital atherectomy (OA), and intravascular lithotripsy (IVL) for managing CN with optical coherence tomography (OCT) guidance.
Consecutive patients undergoing OCT-guided percutaneous coronary intervention (PCI) for severely calcified lesions using RA, OA, or IVL between January 2017 and December 2022 were included. Primary endpoint was minimum stent area (MSA) post-PCI. Secondary endpoints included MSA at CN site and 1-year target vessel failure (TVF), defined as a composite of cardiac death, target-vessel myocardial infarction, or target vessel revascularization.
Among 154 patients and 158 lesions, CN was identified in 54 lesions (34.2%) and managed with RA (39%, n = 21), OA (33%, n = 18), or IVL (28%, n = 15). The IVL group exhibited a larger minimal lumen diameter, maximum calcium arc, and maximum calcium thickness. Post-PCI OCT demonstrated comparable MSA (RA: 6.23 ± 0.34 mm², OA: 5.75 ± 0.39 mm², IVL: 6.24 ± 0.46 mm²; p = 0.62) and MSA at CN site (7.17 ± 0.43 mm², 6.46 ± 0.49 mm², 7.86 ± 0.56 mm², respectively; p = 0.55) after adjusting for morphologic factors. The incidence of TVF at 1 year was similar among the group (RA: 19.0%, OA: 22.2%, IVL: 13.3%, p = 0.81).
In patients undergoing PCI for CN, similar procedural and clinical outcomes can be achieved using RA, OA, or IVL. These findings warrant further investigation in larger, prospective trials.
冠状动脉钙化结节（CN）的最佳治疗策略仍不明确。我们旨在评估在光学相干断层扫描（OCT）引导下，包括旋磨术（RA）、轨道旋磨术（OA）和血管内碎石术（IVL）在内的不同钙化处理策略治疗CN的疗效和安全性。
纳入2017年1月至2022年12月期间连续接受OCT引导下经皮冠状动脉介入治疗（PCI）以处理严重钙化病变的患者，这些患者使用了RA、OA或IVL。主要终点是PCI术后的最小支架面积（MSA）。次要终点包括CN部位的MSA以及1年靶血管失败（TVF），TVF定义为心源性死亡、靶血管心肌梗死或靶血管血运重建的复合终点。
在154例患者和158处病变中，54处病变（34.2%）被识别为CN，并分别采用RA（39%，n = 21）、OA（33%，n = 18）或IVL（28%，n = 15）进行处理。IVL组的最小管腔直径、最大钙化弧和最大钙化厚度更大。PCI术后OCT显示，在调整形态学因素后，各组的MSA（RA：6.23±0.34mm²，OA：5.75±0.39mm²，IVL：6.24±0.46mm²；p = 0.62）以及CN部位的MSA（分别为7.17±0.43mm²、6.46±0.49mm²、7.86±0.56mm²；p = 0.55）相当。各组1年TVF发生率相似（RA：19.0%，OA：22.2%，IVL：13.3%，p = 0.81）。
在接受CN相关PCI的患者中，使用RA、OA或IVL可获得相似的手术和临床结果。这些发现值得在更大规模的前瞻性试验中进一步研究。
