Predictors of target lesion revascularisation after drug-eluting stent implantation for calcified nodules: an optical coherence tomography study

DOI: 10.4244/EIJ-D-22-00836

Tomoyo Hamana
Tomoyo Hamana1, MD; Hiroyuki Kawamori1, MD, PhD; Takayoshi Toba1, MD, PhD; Shunsuke Kakizaki1, MD; Koichi Nakamura1, MD; Daichi Fujimoto1, MD, PhD; Satoru Sasaki1, MD; Hiroyuki Fujii1, MD; Yuto Osumi1, MD; Tomoo Fujioka1, MD; Makoto Nishimori1,2, MD, PhD; Amane Kozuki3, MD, PhD; Junya Shite3, MD, PhD; Masamichi Iwasaki4, MD; Tomofumi Takaya5, MD, PhD; Ken-ichi Hirata1, MD, PhD; Hiromasa Otake1, MD, PhD
1. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; 2. Division of Epidemiology, Kobe University Graduate School of Medicine, Kobe, Japan; 3. Division of Cardiovascular Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan; 4. Department of Cardiology, Hyogo Prefectural Awaji Medical Centre, Sumoto, Japan; 5. Division of Cardiovascular Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan

Background: Evidence of prognostic factors for stent failure after drug-eluting stent implantation for calcified nodules (CNs) is limited.

Aims: We aimed to clarify the prognostic risk factors associated with stent failure among patients who underwent drug-eluting stent implantation for CN lesions using optical coherence tomography (OCT).

Methods: This retrospective, multicentre, observational study included 108 consecutive patients with CNs who underwent OCT-guided percutaneous coronary intervention (PCI). To evaluate the quality of CNs, we measured their signal intensity and analysed the degree of signal attenuation. All CN lesions were divided into dark or bright CNs according to the half width of signal attenuation, greater or lower than 332, respectively.

Results: During the median follow-up period of 523 days, 25 patients (23.1%) experienced target lesion revascularisation (TLR). The 5-year cumulative incidence of TLR was 32.6%. Multivariable Cox regression analysis revealed that younger age, haemodialysis, eruptive CNs, dark CNs assessed by pre-PCI OCT, disrupted fibrous tissue protrusions, and irregular protrusions assessed by post-PCI OCT were independently associated with TLR. The prevalence of in-stent CNs (IS-CNs) observed at follow-up OCT was significantly higher in the TLR group than in the non-TLR group.

Conclusions: Factors such as younger age, haemodialysis, eruptive CNs, dark CNs, disrupted fibrous tissue, or irregular protrusions were independently related to TLR in patients with CNs. The high prevalence of IS-CNs might indicate that the main cause of stent failure implanted in CN lesions could be the recurrence of CN progression in the stented segment.

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calcified stenosisdrug-eluting stentin-stent restenosisoptical coherence tomography
Coronary interventionsStents and scaffolds
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