Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 Apr;40(4):275-284.
doi: 10.1007/s00380-024-02466-7. Epub 2024 Sep 25.

Clinical outcomes of percutaneous coronary intervention for severely calcified lesions: comparison between the morphologies of severely calcified coronary lesions

Yoriyasu Suzuki  1   2 , Masahiro Uehara  3 , Hirohiko Ando  4 , Akihiro Suzuki  4 , Akira Murata  3 , Hiroaki Matsuda  3 , Takahiro Tokuda  3 , Tetsuya Amano  4
Affiliations
Comparative Study

Clinical outcomes of percutaneous coronary intervention for severely calcified lesions: comparison between the morphologies of severely calcified coronary lesions

Yoriyasu Suzuki et al. Heart Vessels. 2025 Apr.

Abstract

Existing studies evaluating the comparison of clinical outcome of percutaneous coronary intervention (PCI) for severe calcified coronary lesions are limited, and the clinical outcomes of PCI for different morphologies of calcified lesions are controversial. Overall, consecutive 576 lesions with severe calcification that were treated with PCI from 2010 to 2021 at Nagoya Heart Center were investigated. All lesions were assessed using invasive coronary angiogram (CAG) or computed tomography-CAG at 12 months after DES implantation. We divided the patients into three groups based on the results of intravascular ultrasound (IVUS) imaging (concentric calcified lesion [CC] n = 273, eccentric calcified lesion [EC] n = 217, calcified nodule [CN] n = 86). The clinical and angiographic outcomes of each group were investigated retrospectively to compare the prognosis between the three groups and identify predictive factors for the device-oriented composite end points (DoCE). There were no differences in patient characteristics among the three groups, except that there were significantly more patients on dialysis in the CN group. The incidence of DoCE was significantly higher in the CN group than in the other groups (CC; 18.3% vs. EC; 23.5% vs. CN; 36.0%; Log-Rank test; p = 0.001). Cox regression analysis showed that the independent predictors of DoCE were CN, insulin use, hemodialysis, right coronary artery lesions, and calcium cracks. The incidence of DoCE was significantly higher in the CN group. Calcium cracks are crucial for improving outcomes in severely calcified lesions, being key predictors of DoCE.

Keywords: Calcification; Drug-eluting stent; Percutaneous coronary intervention.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: All authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Typical IVUS images of target lesions. A concentric calcified lesion, B eccentric calcified lesion, C calcified nodule lesion
Fig. 3
Fig. 3
Typical IVUS images after lesion preparation. A calcium crack (arrow), B calcium shoulder dissection (arrow)
Fig. 4
Fig. 4
Kaplan–Meier curve of each clinical outcome according to the different morphologies of severe calcified coronary lesions. A incidence of DoCE: demonstrates a significantly higher incidence of DoCE in the CN group compared to CC and EC groups (CN: 36.0%, CC: 18.3%, EC: 23.5%; Log-Rank test; p = 0.001). B incidence of TLR: shows the incidence of TLR at 12 months post-DES implantation, with the CN group having the highest TLR rate (CN: 14.0%, EC: 12.4%, CC: 5.1%; p = 0.005). C incidence of cardiovascular death: illustrates the incidence of cardiovascular death among the three groups, with no statistically significant differences observed between the CN, CC, and EC groups. D incidence of MI: presents the incidence of MI across the groups, showing a similar trend with no significant differences between the CN, CC, and EC morphologies
See this image and copyright information in PMC

Comment in

References

    1. Guedeney P, Claessen BE, Mehran R, Mintz GS, Liu M, Sorrentino S, Giustino G, Farhan S, Leon MB, Serruys PW, Smits PC, von Birgelen C, Ali ZA, Généreux P, Redfors B, Madhavan MV, Ben-Yehuda O, Stone GW (2020) Coronary calcification and long-term outcomes according to drug-eluting stent generation. JACC Cardiovasc Interv 13(12):1417–1428 - PubMed
    1. Kuramitsu S, Ohya M, Shinozaki T, Otake H, Horie K, Kawamoto H, Yamanaka F, Natsuaki M, Shiomi H, Nakazawa G, Ando K, Kadota K, Saito S, Kimura T (2019) Risk factors and long-term clinical outcomes of second-generation drug-eluting stent thrombosis. Circ Cardiovasc Interv 12(6):e007822 - PubMed
    1. Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, Généreux P (2014) Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol 63(17):1703–1714 - PubMed
    1. Fujino A, Mintz GS, Lee T, Hoshino M, Usui E, Kanaji Y, Murai T, Yonetsu T, Matsumura M, Ali ZA, Jeremias A, Moses JW, Shlofmitz RA, Kakuta T, Maehara A (2018) Predictors of calcium fracture derived from balloon angioplasty and its effect on stent expansion assessed by optical coherence tomography. JACC Cardiovasc Interv 11(10):1015–1017 - PubMed
    1. Kubo T, Shimamura K, Ino Y, Yamaguchi T, Matsuo Y, Shiono Y, Taruya A, Nishiguchi T, Shimokado A, Teraguchi I, Orii M, Yamano T, Tanimoto T, Kitabata H, Hirata K, Tanaka A, Akasaka T (2015) Superficial calcium fracture after PCI as assessed by OCT. JACC Cardiovasc Imaging 8(10):1228–1229 - PubMed

Publication types

MeSH terms

LinkOut - more resources