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Diagnosis of calcified nodules (CNs) is critical in the proper management of coronary artery disease, but CNs can be detected only using intracoronary imaging modalities. This study aimed to investigate the ability of coronary computed tomography angiography (CCTA) in predicting CNs detected using optical coherence tomography (OCT). From 138 patients who underwent OCT-guided percutaneous coronary intervention (PCI) after CCTA evaluation, 141 PCI target vessels were retrospectively enrolled and classified into CN (12 vessels/11 patients; CNs in the PCI culprit lesion) and non-CN (129 vessels/127 patients; without CNs) groups based on the OCT analysis. Retrospective CCTA analysis revealed significantly higher coronary artery calcification score (CACS), calcified plaque volume (CPV), and maximum calcified plaque area (MCPA) of the target vessel in the CN group than in the non-CN group. Receiver operating characteristic curve indicated that CACS ≥ 162 (area under the ROC curve (AUC 0.76, sensitivity 83.3%, specificity 54.2%), CPV ≥ 20.1 mm3 (AUC 0.83, sensitivity 100%, specificity 57.3%), and MCPA ≥ 4.51 mm2 (AUC 0.87, sensitivity 91.7%, specificity 78.3%) were the best cutoff values for predicting CNs. MCPA showed the highest AUC among all the CCTA parameters. In conclusion, CCTA is useful for predicting OCT-detected CNs in PCI target vessels. [ABSTRACT FROM AUTHOR]

Background: Persistent or late acquired incomplete stent apposition (ISA) may be associated with late or very late stent thrombosis following drug-eluting stent implantation. Presence of calcium at the target lesion may increase the risk of ISA even after rotational atherectomy (RA) followed by stenting with high pressure balloon inflation. The aim of this study is to examine the incidence and characteristics of ISA in heavily calcified lesions.Methods: A total of 52 heavily calcified coronary artery lesions requiring RA plus stenting were selected and studied. After successful ablation followed by stent implantation, optical coherence tomography (OCT) was performed to assess stent expansion and apposition. Presence or absence of ISA was examined and maximal stent strut to vessel wall distance (max SV distance) was measured. In lesions with repeated OCT at follow-up, serial changes in ISA were investigated.Results: ISA was documented in 51 of 52 (98%) lesions. Mean max SV distance was 713 ± 371 μm. In lesions with serial OCT images (n = 11), max SV distance decreased significantly (692.1 ± 420.2 to 462.5 ± 387.0 μm, P < 0.01) but persisted in all but 2 lesions (82%).Conclusions: ISA is frequently documented in heavily calcified lesions requiring RA. Significant ISA still persisted with minimal improvement in SV distance at follow-up. Prognostic impact of the persistent ISA in such calcified lesions needs further investigations. [ABSTRACT FROM AUTHOR]

Background: Coronary artery calcification is highly prevalent in patients with end-stage renal disease (ESRD) on maintenance dialysis. Calcified nodule (CN) is recognized as one of the pathogenic mechanisms of acute coronary syndrome (ACS) and the cause of under expansion after stent implantation. However, the prognostic impact of CN is unclear. The aim of this study is to examine the association between CN and major cardiovascular events (MACE) in patients with ESRD who underwent PCI. Methods: A total of 49 patients with ESRD who underwent PCI were enrolled in this study. CN was defined as distinct calcification with protruding and convex luminal shape by optical coherence tomography (OCT). MACE included all-cause death, non-fatal myocardial infarction, target vessel revascularization (TVR) and stroke. Results: CNs were observed in 29 patients (59.2%). Rotational atherectomy was more frequently used in patients with CN compared with those without CN (27.8% vs. 5.0%; p=0.0448). During a median follow-up of 826 days, all-cause death, TVR and MACE occurred in 7 (14.3%), 11 (22.4%) and 16 (32.7%) patients, respectively. Kaplan-Meier survival analysis revealed that MACE was significantly higher (44.8% vs. 15.0%; p=0.0360) and all-cause death and TVR (20.7% vs. 5.0%; p=0.1994, 31.0% vs. 10.0%; p=0.0791, respectively) tended to be higher in patients with CN compared with those without CN (Figure). Adjusted cox proportional hazards analysis demonstrated that CN was independent predictor of MACE (HR 3.56, 95% CI 1.05-16.6, p=0.0417). Conclusions: CN was associated with MACE in patients with ESRD. [ABSTRACT FROM AUTHOR]