The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Clinical outcome of CALCIFIED NODULEs assessed by OCT: A SUBANALYSIS OF The CLIMA study

DOI: 10.4244/EIJ-D-19-01120

1. Cardiovascular Sciences Department, San Giovanni Addalorata Hospital, Rome, Italy, Italy
2. Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; 2. Centro per la Lotta Contro L’Infarto - CLI Foundation, Rome, Italy
3. Centro Cardiologico Monzino, IRCCS, Milan, Italy
4. Department of Cardiovascular and Thoracic Sciences, University Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
5. Centro per la Lotta Contro L’Infarto - CLI Foundation, Rome, Italy; UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
6. Centro per la Lotta Contro L’Infarto - CLI Foundation, Rome, Italy
7. Centro per la Lotta Contro L’Infarto - CLI Foundation, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, University Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
8. Interventional Cardiology Unit, Ospedale Brotzu, Cagliari, Italy
9. Department of Cardiovascular Diseases, Azienda Ospedaliera Universitaria Senese, Siena, Italy
10. Cardio-Thoracic Vascular Department, Azienda ospedaliero-Universitaria “Policlinico Vittorio-Emanuele”, University of Catania, Catania, Italy
11. Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
12. Department of Cardiology , Hospital Universitario de La Princesa, Madrid, Spain
13. Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Aims: The goal of the present post-hoc analysis of the CLIMA registry was the relationship between calcified nodules (CNs) with (CND) or without (CNWD) disruption of the superficial intimal fibrous rhyme and one-year occurrence of target lesion myocardial infarction (MI) and/or cardiac death.

Methods and results:. CND and CNWD were identified based on the presence or absence of superficial irregularities indicative of disruption of the intimal fibrous rhyme, with possible overlying local thrombus. In total 222 CNs were found in the 1776 non-culprit LAD plaques. CND had larger maximum calcific arc and smaller lumen area. Cardiac death and MI occurred in 20% of patients in the CND group vs 2.7% in the CNWD group and 3.3% in the group without CN (p<0.001). This figure was mainly due to the 13.3% incidence of cardiac death  in the CND group vs 2.0% in the CNWD group and vs 2.2% in the group without CN (p<0.001). The presence of CND was confirmed as an independent predictor of events (HR 6.58, CI 95% 2.7-15.8, p< 0.001). 

Conclusions:. Presence of CND was associated to a high one-year incidence of cardiac death and or target lesion MI.

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