Prevalence, Predictors, and Clinical Presentation of a Calcified Nodule as Assessed by Optical Coherence Tomography
Prevalence, Predictors, and Clinical Presentation of a Calcified Nodule as Assessed by Optical Coherence Tomography
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DOI：
10.1016/j.jcmg.2017.05.013
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发表时间：
2017-08-01
影响因子：
14
通讯作者：
Maehara, Akiko
中科院分区：
文献类型：
--
作者：
Lee, Tetsumin;Mintz, Gary S.;Maehara, Akiko
本研究旨在确定与钙化结节（CN）相关的解剖学特征和临床表现，通过光学相干断层扫描进行评估。背景CN是急性冠状动脉综合征（ACS）的一种不常见但可证实的原因。CN被定义为结节性钙化的爆发性积聚（小的断裂钙化）。采用定量冠状动脉造影，测量病变在舒张期和收缩期之间的角度变化（血管造影Delta角）。结果CN出现在所有病变的4.2%，更常见的是位于开口或中部的右冠状动脉。血液透析（比值比：4.0; 95%置信区间：1.1至13.4; p = 0.04）、病变血管造影D角（比值比：1.09; 95%置信区间：1.05至1.14; p < 0.001）和光学相干断层扫描的最大钙弧（比值比：1.02; 95%置信区间：1.01至1.02; p < 0.001）与多变量模型中CN的存在显著相关。当我们比较ACS与稳定型心绞痛患者的CN时，（1.04 mm 2 [第一四分位数，第三四分位数：0.69，1.26] vs. 1.61 [第一四分位数，第三四分位数：1.03，2.06] mm（2）; p = 0.02）伴有更多血栓（82.4% vs. 20.0%; p < 0.001）。在严重钙化病变（最大钙弧> 180度），30%的ACS罪犯病变包含CN，CN的存在与ACS表现独立于其他易损斑块morphology.CONCLUSIONS CN的存在与严重钙化和冠状动脉（尤其是开口和右冠状动脉中段）较大的铰链运动有关。ACS患者严重钙化的罪犯病变的基础斑块形态中有三分之一是由CN引起的。(C)2017年由美国心脏病学会基金会。
OBJECTIVES This study sought to determine the anatomic characteristics and clinical presentation associated with a calcified nodule (CN) as assessed by optical coherence tomography.BACKGROUND CN is an unusual but demonstrable cause of acute coronary syndromes (ACS).METHODS We studied 889 de novo culprit lesions in 889 patients (48% ACS) who underwent optical coherence tomography before intervention. CN was defined as an eruptive accumulation of nodular calcification (small fractured calcifications). Using quantitative coronary angiography, the change in the angle of the lesion between diastole and systole was measured (angiographic Delta angle).RESULTS CN was seen in 4.2% of all lesions and was located more frequently in the ostial or mid right coronary artery. Hemodialysis (odds ratio: 4.0; 95% confidence interval: 1.1 to 13.4; p = 0.04), in-lesion angiographic D angle (odds ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001), and maximum calcium arc by optical coherence tomography (odds ratio: 1.02; 95% confidence interval: 1.01 to 1.02; p < 0.001) were significantly associated with the presence of a CN in the multivariable model. When we compared CNs in patients with ACS versus stable angina presentation, there was a smaller minimum lumen area (1.04 mm2 [first quartile, third quartile: 0.69, 1.26] vs. 1.61 [first quartile, third quartile: 1.03, 2.06] mm(2); p = 0.02) accompanied by more thrombus (82.4% vs. 20.0%; p < 0.001) in CN lesions with ACS presentation. In lesions with severe calcification (maximum calcium arc > 180 degrees), 30% of ACS culprit lesions contained a CN, and the presence of a CN was associated with ACS presentation independent of other vulnerable plaque morphologies.CONCLUSIONS The presence of a CN was associated with severe calcification and larger hinge movement of the coronary artery (especially ostial and mid right coronary artery). One-third of the underlying plaque morphology of severely calcified culprit lesions in patients with ACS was caused by a CN. (C) 2017 by the American College of Cardiology Foundation.