Focused Issue: CAC Imaging
Original Research
Prevalence, Predictors, and Clinical Presentation of a Calcified Nodule as Assessed by Optical Coherence Tomography

https://doi.org/10.1016/j.jcmg.2017.05.013Get rights and content
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Abstract

Objectives

This study sought to determine the anatomic characteristics and clinical presentation associated with a calcified nodule (CN) as assessed by optical coherence tomography.

Background

CN is an unusual but demonstrable cause of acute coronary syndromes (ACS).

Methods

We studied 889 de novo culprit lesions in 889 patients (48% ACS) who underwent optical coherence tomography before intervention. CN was defined as an eruptive accumulation of nodular calcification (small fractured calcifications). Using quantitative coronary angiography, the change in the angle of the lesion between diastole and systole was measured (angiographic Δ angle).

Results

CN was seen in 4.2% of all lesions and was located more frequently in the ostial or mid right coronary artery. Hemodialysis (odds ratio: 4.0; 95% confidence interval: 1.1 to 13.4; p = 0.04), in-lesion angiographic Δ angle (odds ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001), and maximum calcium arc by optical coherence tomography (odds ratio: 1.02; 95% confidence interval: 1.01 to 1.02; p < 0.001) were significantly associated with the presence of a CN in the multivariable model. When we compared CNs in patients with ACS versus stable angina presentation, there was a smaller minimum lumen area (1.04 mm2 [first quartile, third quartile: 0.69, 1.26] vs. 1.61 [first quartile, third quartile: 1.03, 2.06] mm2; p = 0.02) accompanied by more thrombus (82.4% vs. 20.0%; p < 0.001) in CN lesions with ACS presentation. In lesions with severe calcification (maximum calcium arc >180°), 30% of ACS culprit lesions contained a CN, and the presence of a CN was associated with ACS presentation independent of other vulnerable plaque morphologies.

Conclusions

The presence of a CN was associated with severe calcification and larger hinge movement of the coronary artery (especially ostial and mid right coronary artery). One-third of the underlying plaque morphology of severely calcified culprit lesions in patients with ACS was caused by a CN.

Key Words

calcium
imaging
optical coherence tomography
plaque

Abbreviations and Acronyms

ACS
acute coronary syndromes
CI
confidence interval
CN
calcified nodule
IVUS
intravascular ultrasound
OCT
optical coherence tomography
OR
odds ratio
RCA
right coronary artery
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

Dr. Mintz is a consultant for or has received honoraria from Boston Scientific, ACIST, and Volcano; and has received fellowship/grant support from Volcano, St. Jude, and Boston Scientific. Dr. Maehara has received grant support from Boston Scientific and St. Jude Medical; is a consultant for Boston Scientific and OCT Medical Imaging; and has received speaker fees from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. H. Vernon Anderson, MD, served as the Guest Editor for this article.