Cardiac outcomes in patients with acute coronary syndrome attributable to calcified nodule
Cardiac outcomes in patients with acute coronary syndrome attributable to calcified nodule
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DOI：
10.1016/j.atherosclerosis.2020.11.005
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发表时间：
2021-01-23
期刊：
影响因子：
5.3
通讯作者：
Yasuda, Satoshi
中科院分区：
文献类型：
--
作者：
Sugane, Hiroki;Kataoka, Yu;Yasuda, Satoshi
背景与目的：钙化结节（calcifiednodule，CN）是引起急性冠状动脉综合征（acutecoronarysyndrome，ACS）的发疹性钙化肿块。由于冠状动脉钙化与心脏事件的风险升高，ACS归因于CN可能会表现出更糟糕的临床结果经皮冠状动脉介入治疗（PCI）。方法：我们回顾性分析了657例ACS患者接受PCI与新一代药物洗脱支架（DES）植入血管内超声（IVUS）引导下。CN定义为（1）表面不规则的突出钙化和（2）邻近近端和远端节段存在钙化。主要终点是主要不良心脏事件的复合终点[MACE =心源性死亡+ ACS复发+靶病变血运重建（TLR）]。CN患者更可能有冠状动脉危险因素，包括高血压（p = 0.005）、慢性肾脏疾病（p < 0.001）、维持性血液透析（p < 0.001）和PCI病史（p < 0.001）。在观察期内（中位数= 1304天），CN与MACE风险增加相关（HR = 7.68，95%CI = 4.61-12.80，p < 0.001），ACS复发（HR = 12.32，95%CI = 6.05-25.11，p < 0.001）和TLR（HR = 10.48，95%CI = 5.80-18.94，p < 0.001）。通过考克斯比例风险模型（MACE：p < 0.001，ACS复发：p <0.001，TLR：p <0.001）和倾向评分匹配队列分析（MACE：p = 0.002，ACS复发：p = 0.01，TLR：p = 0.005）一致观察到CN相关的这些心脏风险。值得注意的是，超过80%的TLR在CN病变是由其内植入的DES的再现驱动。结论：ACS患者归因于CN的ACS复发和TLR的风险增加，主要是由钙化肿块的持续增长和突出。
Background and aims: Calcified nodule (CN) is an eruptive calcified mass causing acute coronary syndrome (ACS). Since coronary calcification is associated with an elevated cardiac event's risk, ACS attributable to CN may exhibit worse clinical outcome following percutaneous coronary intervention (PCI).Methods: We retrospectively analyzed 657 ACS patients receiving PCI with newer-generation drug-eluting stent (DES) implantation under intravascular ultrasound (IVUS) guidance. CN was defined as (1) protruding calcification with its irregular surface and (2) the presence of calcification at adjacent proximal and distal segments. The primary endpoint was a composite of major adverse cardiac event [MACE = cardiac death + ACS recurrence + target lesion revascularization (TLR)].Results: CN was identified in 5.3% (=35/657) of the study subjects. CN patients were more likely to have coronary risk factors including hypertension (p = 0.005), chronic kidney disease (p < 0.001), maintenance hemodialysis (p < 0.001) and a history of PCI (p < 0.001). During the observational period (median = 1304 days), CN was associated with an increased risk of MACE (HR = 7.68, 95%CI = 4.61-12.80, p < 0.001), ACS recurrence (HR = 12.32, 95%CI = 6.05-25.11, p < 0.001) and TLR (HR = 10.48, 95%CI = 5.80-18.94, p < 0.001). These cardiac risks related to CN were consistently observed by Cox proportional hazards model (MACE: p < 0.001, ACS recurrence: p < 0.001, TLR: p < 0.001) and a propensity score-matched cohort analysis (MACE: p = 0.002, ACS recurrence: p = 0.01, TLR: p = 0.005). Of note, over 80% of TLR at the CN lesion was driven by its reappearance within the implanted DES.Conclusions: ACS patients attributable to CN have an increased risk of ACS recurrence and TLR, mainly driven by the continuous growth and protrusion of the calcified mass.