Abstract 12874: Impact of Calcified Nodule in Patients Undergoing Rotablator Atherectomy

Abstract

Introduction: Impact on clinical outcome of the patient with calcified nodule remain unknown. Calcified nodule may cause suboptimal stent expansion, stent mal-apposition. Hypothesis: We hypothesized that the presence of calcified nodule in the heavy calcified lesion undergoing rotablator atherectomy (RA) assisted percutaneous coronary intervention (PCI) increased device-oriented composite endpoint (DoCE). Methods: We retrospective reviewed consecutives patient with heavy calcified lesion underwent RA assisted intravascular ultrasound (IVUS) guidance PCI between August 2016-April 2020. Pre-procedural IVUS imaging was mandatory. Calcified nodule was defined as convex shape of luminal surface and luminal side of calcium with protruding in the coronary artery lumen that assessed by IVUS. Primary outcome was cumulative 5-year composite device-oriented composite endpoint (DoCE), define as composite of CV death, myocardial infarction and clinically-driven target lesion revascularization (CDTLR). Results: Two-hundred consecutives patient with heavy calcified lesion underwent RA assisted intravascular ultrasound (IVUS) guidance PCI was enrolled. Calcified nodule was found in 87 patients (43.5%) with heavily calcified lesions. Cumulative 5-year DoCE was significantly higher in the presence of calcified nodule group than in the non-calcified nodule group (20.7% vs 8.8%, P=0.02). Calcified nodule group has the higher incidence of under-expansion and asymmetrical expansion of stent. The patient who had calcified nodule with eccentric calcification has significantly higher cumulative 5-year DoCE compared to calcified nodule with concentric calcification (p<0.01). Conclusions: The presence of calcified nodule in the heavily calcified lesion underwent RA assisted PCI increased with cumulative 5-year DoCE.