TLR associated factors in patients with calcified nodules.
Patients with complex cardiomyopathies undergoing percutaneous coronary intervention are increasingly common, as is the case for calcified lesions and calcified nodules (CN). Procedure complexity not only involves planning, but also establishing patient prognosis, taking into consideration the fact that most target vessel events occur at long term followup.
Intravascular imaging will allow more specific characterization and prognosis. With this idea in mind, Tomoyo H and Col designed this study, aiming at clarifying prognostic factors associated to stent failure in patients with calcified nodules undergoing optical coherence tomography (OCT).
This was a retrospective, observational study of consecutive patients with coronary artery disease undergoing PCI in four centers in Japan. These patients had calcified nodules (well-defined image adjacent to calcified plaque) in the culprit vessel, showed by OCT prior intervention. Patients with no DES, with instent restenosis, or bypass lesion, were excluded.
CN lesions were classified into eruptive (ECNs) or calcified protrusions (CPs). Following procedure, a qualitative analysis of CNs was carried out according to signal attenuation, with OCT.
Primary end point was target vessel revascularization (TVR) defined as target vessel percutaneous or surgical intervention. Data from 108 patients was collected, mean age 67, 70% men. Mean followup was 523 days. Average incidence of TLR at 5 years was 32.6%.
TLRs were mainly at ostial level and in segments with longer stents. The prevalence of NCs in vessels with TLR was higher vs. no TLR (76% vs 41%; p=0.02).
Qualitative assessment revealed lower attenuation of width behind CNs in patients with revascularization (event cutoff value = 332). CNs were classified into dark (<332) or bright (>332), and TLR patients had higher incidence of dark CNs.
Read also: TAVI in Moderate Aortic Stenosis with Low Ejection Fraction.
Multivariable analysis identified TLR predictors as dialysis, young age, presence of ECNs and dark CNs. Researchers also looked at events in four subgroups according to OCT (the presence of dark or bright ECNs or PCs). Event incidence at 5 years was far higher in patients with ECNs and dark CNs (53% vs 8,5%; HR 5.34, CI 95% 1.55-18; p=0.008).
Conclusions
There was a 32,6% TLR rate in patients with CNs. Clinical characteristics associated to higher TLR were hemodialysis and young age, while dark CNs and ECNs prior PCI had higher rates of revascularization at followup.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Reference: Hamana T, Kawamori H, Toba T, Kakizaki S, Nakamura K, Fujimoto D, Sasaki S, Fujii H, Osumi Y, Fujioka T, Nishimori M, Kozuki A, Shite J, Iwasaki M, Takaya T, Hirata KI, Otake H. Predictors of target lesion revascularisation after drug-eluting stent implantation for calcified nodules: an optical coherence tomography study. EuroIntervention. 2023 Jun 5;19(2):e123-e133. doi: 10.4244/EIJ-D-22-00836. PMID: 36876497; PMCID: PMC10240727.
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