Original Research

DOI: 10.4244/EIJ-D-24-00362

Natural history of a newly developed calcified nodule: incidence, predictors, and clinical outcomes

Yoichiro Sugizaki1,2,3,4, MD, PhD; Mitsuaki Matsumura1, PhD; YuWei Chen1,3, MD; Takunori Tsukui1,2,3, MD, PhD; Evan Shlofmitz2, DO; Susan V. Thomas2, MPH; Sarah Malik2, MD; Ali Dakroub2, MD; Mandeep Singh2, BS; Doosup Shin2, MD; Matthew J. Granville2, BA; Jordan M. Busch2, BS; Eric H. Wolff2, BS; Genie M. Miraglia2, BS; Jeffrey W. Moses1,2,3, MD; Omar K. Khalique1,2, MD; David J. Cohen1,2, MD, MSc; Gary S. Mintz1, MD; Richard A. Shlofmitz2, MD; Allen Jeremias1,2, MD, MSc; Ziad A. Ali1,2,5, MD, DPhil; Akiko Maehara1,3, MD

Abstract

Background: Calcified nodules (CNs) are an increasingly important, high-risk lesion subset.

Aims: We sought to identify the emergence of new CNs and the relation between underlying plaque characteristics and new CN development.

Methods: Patients who had undergone two optical coherence tomography (OCT) studies that imaged the same untreated calcified lesion at baseline and follow-up were included. New CNs were an accumulation of small calcium fragments at follow-up that were not present at baseline. Cardiac death, myocardial infarction (MI), or clinically driven revascularisation related to OCT-imaged, but untreated, calcified lesions were then evaluated.

Results: Among 372 untreated calcified lesions, with a median of 1.5 (first and third quartiles: 0.7-2.9) years between baseline and follow-up OCTs, new CNs were observed in 7.0% (26/372) of lesions at follow-up. Attenuated calcium representing residual lipid (odds ratio [OR] 3.38, 95% confidence interval [CI]: 1.15-9.98; p=0.03); log10 calcium volume index (length×maximum arc×maximum thickness; OR 2.76, 95% CI: 1.10-6.95; p=0.03); angiographic Δangle between systole and diastole, per 10° (OR 2.30, 95% CI: 1.25-4.22; p=0.01); and time since baseline OCT, per year (OR 1.36, 95% CI: 1.05-1.75; p=0.02) were all associated with new CN development. Clinical events were revascularisation and/or MI and were more frequent in lesions with versus without a new CN (29.3% vs 15.3%; p=0.04).

Conclusions: New CNs developed in untreated, lipid-containing, severely calcified lesions with a larger angiographic hinge motion (between systole and diastole), compared with lesions without CNs, and were associated with worse clinical outcomes.

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Volume 20 Number 21
Nov 4, 2024
Volume 20 Number 21
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