Clinical impact of calcified nodule in patients with heavily calcified lesions requiring rotational atherectomy
Clinical impact of calcified nodule in patients with heavily calcified lesions requiring rotational atherectomy
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DOI：
10.1002/ccd.28896
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发表时间：
2020-04-07
影响因子：
2.3
通讯作者：
Ando, Kenji
中科院分区：
文献类型：
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作者：
Morofuji, Toru;Kuramitsu, Shoichi;Ando, Kenji
目的 我们旨在评估需要旋磨术 (RA) 的重度钙化病变患者中钙化结节 (CN) 的发生率和临床影响。 背景 目前尚不清楚 CN 是否会对重度钙化病变患者的临床结果产生不利影响。 方法 回顾性纳入 2011 年 1 月至 2014 年 2 月期间 RA 后植入第二代药物洗脱支架 (DES) 的 264 例患者。 CN 被定义为通过血管内超声评估的钙管腔侧的凸形形状。主要终点是主要不良心脏事件 (MACE) 的 5 年累积发生率，定义为心源性死亡、临床驱动的靶病灶血运重建 (CDTLR) 和明确的支架血栓形成 (ST) 的综合结果。 结果 在 128 名患有严重钙化病灶的患者 (48.5%) 中观察到 CN。 CN 组的 MACE 累积 5 年发生率显着高于非 CN 组，主要是由于 CDTLR 和 ST 的发生率较高（分别为 35.4% vs. 18.8%，p < .001；23.2% vs. 7.9%，p < .001；7.0% vs. 0.93%，p = .009）。 5 年 MACE 的独立危险因素包括血液透析（风险比 [HR] = 3.39，95% 置信区间 [CI]：2.00-5.73，p < .001）、CN（HR = 2.53，95% CI：1.49-4.27，p < .001）、孔口病变（HR = 3.02，95% CI： 1.58-5.78，p = .001)，左心室射血分数
Objectives We sought to evaluate the incidence and clinical impact of calcified nodule (CN) in patients with heavily calcified lesions requiring rotational atherectomy (RA).Background It remains unclear whether CN impacts adversely on clinical outcomes in patients with heavily calcified lesions.Methods Between January 2011 and February 2014, 264 patients after second-generation drug-eluting stent (DES) implantation following RA were retrospectively enrolled. CN was defined as a convex shape of the luminal side of calcium as assessed by intravascular ultrasound. The primary endpoint was the cumulative 5-year incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, clinically driven target lesion revascularization (CDTLR), and definite stent thrombosis (ST).Results CN was observed in 128 patients (48.5%) with heavily calcified lesions. Cumulative 5-year incidence of MACE was significantly higher in the CN group than in the non-CN group, mainly driven by a higher rate of CDTLR and ST (35.4% vs. 18.8%, p < .001; 23.2% vs. 7.9%, p < .001; 7.0% vs. 0.93%, p = .009, respectively). Independent risk factors of 5-year MACE included hemodialysis (hazard ratio [HR] = 3.39, 95% confidence intervals [CI]: 2.00-5.73, p < .001), CN (HR = 2.53, 95% CI: 1.49-4.27, p < .001), ostial lesion (HR = 3.02, 95% CI: 1.58-5.78, p = .001), left ventricular ejection fraction