Features and Outcomes of Patients with Calcified Nodules at Culprit Lesions of Acute Coronary Syndrome: An Optical Coherence Tomography Study

Abstract

Objectives: We sought to clarify clinical features and outcomes related to calcified nodules (CN) compared with plaque rupture (PR) and plaque erosion (PE) detected by optical coherence tomography (OCT) at the culprit lesions in patients with acute coronary syndrome (ACS). Methods: Based on OCT findings for culprit lesion plaque morphologies, ACS patients with analyzable OCT images (n = 362) were classified as CN, PR, PE, and other. Results: The prevalence of CN, PR, and PE was 6% (n = 21), 45% (n = 163), and 41% (n = 149), respectively. Patients with CN were older (median 71 vs. 65 years, p = 0.03) and more diabetic (71 vs. 35%, p = 0.002) than those without CN. In OCT findings, the distal reference lumen cross-sectional area (median 4.2 vs. 5.2 mm², p = 0.048) and the postintervention minimum lumen cross-sectional area (median 4.5 vs. 5.3 mm², p = 0.04) were smaller in lesions with CN than in those without. Kaplan-Meier estimate survival curves showed that the 500-day survival without target lesion revascularization (TLR) was lower (p = 0.011) for patients with CN (72.9%) than for those with PR (89.3%) or PE (94.8%). Conclusions: ACS patients with CN at the culprit lesion had more TLR compared to those with PR or PE.

Calcification in Atherosclerotic Plaque Vulnerability: Friend or Foe?

“…Moreover, calcified nodules in patients with ACS have more thrombi than those in patients with SAP (Lee et al, 2017). These findings are consistent with another OCT study (Kobayashi et al, 2018). Eruptive calcified nodules (expulsion of small calcific nodules into the lumen) showed predominantly red thrombi, whereas superficial calcific sheets had predominant white thrombi (Sugiyama et al, 2019).…”

Calcified Nodule as the Cause of Acute Coronary Syndrome: Connecting Bench Observations to the Bedside

“…Lastly, and perhaps most intriguing is the outcomes data presented by Kobayashi et al [5]. To the best of our knowledge this is the first data set to clearly show an important clinical outcome related to the identification of calcified nodule.…”

“…To conclude, the work of Kobayashi et al [5] represents another important step in our understanding of calcified nodule by reinforcing its existence in living patients presenting with ACS and suggests there are important consequences in patients receiving revascularization. Progress in the field of coronary intervention requires that we look beyond the limits of angiography into an era where we can turn pathology observations into new insights with potential implications for the treatment of our patients.…”

“…In this issue of Cardiology , Kobayashi et al [5] shed new light upon the entity of calcified nodule, using OCT to identify plaque morphologies in 417 ACS patients from a single center in Japan. The authors reported plaque rupture in 45%, followed by plaque erosion in 41.0% and calcified nodule in 6%.…”

Impact of Accumulated Serum Uric Acid on Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Cardiac Outcomes in Patients with Acute Coronary Syndrome

“…OCT imaging of culprit lesions was performed using either a commercially available time-domain OCT (Model M3 Cardiology Imaging System, St. Jude Medical, Westford, MA, USA) or a frequency-domain OCT (C7XR system and the Dragonfly imaging catheter, St. Jude Medical). The OCT procedure has been reported previously [11, 16]. …”