Coronary interventions - Mini focus: Plaque characteristics

Clinical outcomes of calcified nodules detected by optical coherence tomography: a sub-analysis of the CLIMA study

EuroIntervention 2020;16:380-386. DOI: 10.4244/EIJ-D-19-01120

Francesco Prati
Francesco Prati1,2,3, MD; Laura Gatto1,2, MD; Franco Fabbiocchi4, MD; Rocco Vergallo5, MD, PhD; Giulia Paoletti2,3, RN; Giovanni Ruscica2, MD; Valeria Marco2, RN; Enrico Romagnoli2,5, MD, PhD; Alberto Boi6, MD; Massimo Fineschi7, MD; Giuseppe Calligaris4, MD; Corrado Tamburino8, MD; Filippo Crea5, MD; Yukio Ozaki9, MD; Fernando Alfonso10, MD; Eloisa Arbustini11, MD
1. Cardiovascular Sciences Department, San Giovanni Addalorata Hospital, Rome, Italy; 2. Centro per la Lotta Contro L’Infarto - CLI Foundation, Rome, Italy; 3. UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy; 4. Centro Cardiologico Monzino, IRCCS, Milan, Italy; 5. Department of Cardiovascular and Thoracic Sciences, University Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; 6. Interventional Cardiology Unit, Ospedale Brotzu, Cagliari, Italy; 7. Department of Cardiovascular Diseases, Azienda Ospedaliera Universitaria Senese, Siena, Italy; 8. Cardio-Thoracic Vascular Department, Azienda ospedaliero-Universitaria “Policlinico Vittorio-Emanuele”, University of Catania, Catania, Italy; 9. Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan; 10. Department of Cardiology , Hospital Universitario de La Princesa, Madrid, Spain; 11. Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

Aims: The goal of the present post hoc analysis of the CLIMA registry was to establish the relationship between calcified nodules (CNs) with (CND) or without (CNWD) disruption of the superficial intimal fibrous layer 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 layer, with possible overlying local thrombus. In total, 222 CNs were found in the 1,776 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 versus 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 versus 2.0% in the CNWD group and versus 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, 95% CI: 2.7-15.8, p<0.001).

Conclusions: The presence of CND was associated with a high one-year incidence of cardiac death and/or target lesion MI.

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