Clinical impact of calcified nodule in patients with heavily calcified lesions requiring rotational atherectomy

Abstract

Objectives We sought to evaluate the incidence and clinical impact of calcified nodule (CN) in patients with heavily calcified lesions requiring rotational atherectomy (RA). Background It remains unclear whether CN impacts adversely on clinical outcomes in patients with heavily calcified lesions. Methods Between January 2011 and February 2014, 264 patients after second‐generation drug‐eluting stent (DES) implantation following RA were retrospectively enrolled. CN was defined as a convex shape of the luminal side of calcium as assessed by intravascular ultrasound. The primary endpoint was the cumulative 5‐year incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, clinically driven target lesion revascularization (CDTLR), and definite stent thrombosis (ST). Results CN was observed in 128 patients (48.5%) with heavily calcified lesions. Cumulative 5‐year incidence of MACE was significantly higher in the CN group than in the non‐CN group, mainly driven by a higher rate of CDTLR and ST (35.4% vs. 18.8%, p < .001; 23.2% vs. 7.9%, p < .001; 7.0% vs. 0.93%, p = .009, respectively). Independent risk factors of 5‐year MACE included hemodialysis (hazard ratio [HR] = 3.39, 95% confidence intervals [CI]: 2.00–5.73, p < .001), CN (HR = 2.53, 95% CI: 1.49–4.27, p < .001), ostial lesion (HR = 3.02, 95% CI: 1.58–5.78, p = .001), left ventricular ejection fraction ≤40% (HR = 2.17, 95% CI: 1.27–3.70, p = .005), and right coronary artery lesion (HR = 1.82, 95% CI: 1.07–3.11, p = .03). Conclusions CN was observed in 48.5% of heavily calcified lesions, resulting in unfavorable long‐term clinical outcomes after second‐generation DES implantation following RA.