Prevalence, Distribution, Predictors, and Outcomes of Patients with Calcified Nodules in Native Coronary Arteries: A Three-Vessel Intravascular Ultrasound Analysis from PROSPECT
Background—Pathologic studies suggest that calcified coronary nodules are a rare cause of thrombotic events. The frequency, distribution, predictors, and outcomes of calcified nodules have never been described.
Methods and Results—Following successful stenting in 697 patients (167 female, median age=58.1 years) with acute coronary syndromes (ACS), three-vessel grayscale and virtual histology (VH) intravascular ultrasound (IVUS) was performed in the proximal-mid segments of all three coronary arteries as part of a prospective, multicenter study. Based on recent histologic validation, an independent core lab identified calcified nodules as distinct calcification with an irregular, protruding and convex luminal surface. Patients were followed for (median) three years. Overall, 314 calcified nodules were detected in 250 of 1573 analyzable arteries (185 of 623 patients). Thus, the prevalence of calcified nodules was 17% per artery and 30% per patient. Two or more calcified nodules were detected in 48 coronary arteries (3%) in 76 patients (12%). The location of the calcified nodules were <40mm of the ostium of the coronary artery in 85% of LAD and 86% of LCX while calcified nodules within the RCA were evenly and more distally distributed. Patients with calcified nodules were significantly older, had more plaque volume, and more thick-cap fibroatheroma, but fewer non-culprit lesion major adverse events on follow-up.
Conclusions—Calcified nodules in untreated non-culprit coronary segments in patients with ACS were more prevalent than previously recognized. Although their distribution mirrored the origin of most thrombotic events, calcified nodules caused fewer major adverse events during 3-years of follow-up.
- Received July 8, 2011.
- Accepted May 18, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited