Abstract 13826: Patient Characteristics and Prognosis of OCT Verified Calcified Nodules in Acute Coronary Syndrome

Abstract

Backgrounds: Pathological studies have shown that calcified nodule (CN) is one of important causes for acute coronary syndrome (ACS). Optical coherence tomography (OCT) is able to identify CN in vivo. No data, however, is available for prognosis of CN. Purpose: The purpose of this study was to investigate the prognosis of CN. Methods: This study consisted of 492 patients with ACS on native coronary artery who underwent pre-PCI OCT to explore the culprit artery. Patients were divided into a CN group and a non-CN group according to OCT findings. The OCT criterion of CN was defined when fibrous cap disruption was detected over a calcified plaque characterized by protruding calcification, superficial calcium, and the presence of substantive calcium proximal and/or distal to the lesion. The primary end-point was overall survival. The secondary end-point was composite of major adverse cardiac events (MACE) including cardiac death, non-fetal myocardial infarction (MI), and unstable angina pectoris (uAP). Results: The prevalence of OCT-CN was 4.5% (n=22). Patients with CN were significantly older (CN: 75.4±9.0 vs. non-CN: 66.7±11.3, p<0.01), and more likely to female (CN: 50% vs. non-CN: 23%, p<0.01). Compared with non-CN patients, hypertension (CN: 95% vs. non-CN: 71%, p<0.01), and hemodialysis (CN: 18% vs. non-CN: 3%, p<0.01) were more common in CN. Mean follow-up period was 25.4 (range 1-60) month. During the period, cardiac death occurred in 19 (CN: 1, non-CN: 18), non-cardiac death in 15 (CN: 3, non-CN: 12), non-fatal MI in 7 non-CNs, and uAP in 11 non-CNs. Kaplan-Meier curve showed significantly low overall survival in CN (Figure A, p<0.05), while MACE were similar in both groups (Figure B, p=0.42). Conclusions: The prevalence of OCT-CN was 4.5%. Patients with CN were older, and had more co-morbidities including hypertension and kidney dysfunction. The overall survival was significantly poor in patients with CN, although the MACE free survival were similar between groups.