Stent-Edge Hinge Movement in a Calcified Lesion Is Associated With Increased Prevalence of a Calcified Nodule at Follow-Up.

BACKGROUND

Coronary stenting alters vessel dynamics, displacing hinge movement closer to stent edges. We aimed to investigate whether calcified nodules (CNs) are more frequent at stent edges associated with calcium.

METHODS

In vessels with previously implanted stents evaluated by optical coherence tomography, 4 different calcified lesions were studied: stent-edge calcified lesions with or without a CN, and unstented native calcified lesions with or without a CN.

RESULTS

In 801 patients, 989 stent-edge calcified lesions and 354 unstented native calcified lesions were identified. Stent-edge calcified lesions exhibited a higher prevalence of CNs versus native calcified lesions (15.7% versus 5.1%; P<0.001) and were observed in locations (mid left anterior descending artery, mid left circumflex, or branches) where no unstented native vessel CNs were seen. Stent-edge (versus native vessel) location (odds ratio [OR], 4.58 [95% CI, 2.23-9.43]) predicted the presence of a CN. Correspondingly, greater angiographic (systole-diastole) ∆angle at the stent edge or unstented lesion (per 10°, OR, 2.27 [95% CI, 1.43-3.60]) and greater calcium burden: calcium length (per 10 mm, OR, 4.04 [95% CI, 2.36-6.92]), maximum calcium arc (per 90°, OR, 1.65 [95% CI, 1.25-2.17]), and maximum calcium thickness (per 0.1 mm, OR, 1.25 [95% CI, 1.15-1.36]) were associated with the presence of a CN. Stent-edge CNs were associated with a higher rate of stent-edge calcified lesion-related major adverse cardiac events (a composite of cardiac death, target vessel-related myocardial infarction, clinically driven target lesion revascularization, or definite/probable stent thrombosis) compared with stent edges without a CN (15.9% versus 6.5%; P=0.01), mainly driven by target lesion revascularization.

CONCLUSIONS

Stent-edge calcium may predispose to the development of a CN. Stent-edge CNs were associated with a higher major adverse cardiac events rate than stent edges without a CN, whether treated or untreated.