Abstract 13084: Clinical Outcomes and Factors for Adverse Events in Patients With Severe Coronary Calcification Assessed by Optical Coherence Tomography

Abstract

Introduction: Severe coronary calcification is a known factor for worse clinical and angiographic outcomes after percutaneous coronary intervention (PCI). However, the association between lesion characteristics and post-stent findings and worse clinical outcomes in patients with severely calcified lesions remains to be elucidated. Hypothesis: Among patients with severely calcified lesions, pre and post stent findings assessed by optical coherence tomography (OCT) are associated with future adverse events. Methods: A total of 241 consecutive patients with severely calcified lesions, who underwent OCT imaging of the culprit lesion were included. Severely calcified lesion was defined as a lesion with a maximum calcium angle >180°, maximum thickness >0.5 mm and calcium length >5 mm, which were assessed by OCT. The device-oriented clinical endpoint (DoCE) was defined as a composite of cardiac death, target vessel-related myocardial infarction, ischemia-driven target lesion revascularization, and stent thrombosis. Results: The presence of eruptive calcified nodule (eCN) (41% vs. 18%, p =0.003) in the culprit lesion and medial dissection with calcified flaps (59% vs. 26%, p <0.001) after stenting was significantly higher in patients with DoCE than in those without. Among the four groups classified by the presence of eCN and medial dissection with calcified flap, incidence of DoCE was the highest in lesions with both eCN and medial dissection with calcified flap ( p <0.001) (Figure). Conclusions: An increased incidence of DoCE was demonstrated in lesions with the combined presence of eCN and medial dissection with calcified flap. The present results may explain the importance of the careful assessment of severely calcified lesions using OCT for the risk stratification of future adverse events.