Clinical significance of radial wall strain at coronary calcified sites: the mediating role of eruptive calcified nodules
H Yan, W LiuAbstract
Background and aims
Coronary calcification types, particularly eruptive calcified nodules (ECN) are associated with adverse events. Angiography-derived radial wall strain (RWS) offers a feasible alternative to assess plaque biomechanics. This study aimed to explore the association of RWS with calcification subtypes and its prognostic role in coronary calcification.
Methods
In 241 patients with 258 deferred calcified lesions, The maximum RWS (RWSmax) was quantified from angiography using AngioPlus software. Calcification types (ECN, nodular calcification [NC], superficial calcific sheet [SCS]) were classified by optical coherence tomography. The primary endpoint was lesion-oriented composite endpoint (LOCE: cardiac death, target vessel MI, or clinically driven revascularisation) with median 1.5-year follow-up.
Results
Among 258 lesions, 43 (16.7%) were ECN, 26 (10.1%) were NC, and 189 (73.3%) were SCS. RWSmax was significantly higher in ECN than in NC and SCS (13.8% vs 10.6% vs 8.2%, P<0.001). RWSmax independently predicted ECN (adjusted OR = 1.46, 95% CI 1.26–1.70, P<0.001) with an area under the curve of 0.817 (95% CI 0.752–0.881, P<0.001). RWSmax ≥11% correlated with adverse morphological features: higher eccentricity (P<0.001), and more calcium with attenuation (P=0.017). Lesions with RWSmax≥11% had a higher LOCE risk (adjusted HR=2.91, 95%CI:1.03–8.27, P=0.044) . Mediation analysis showed ECN explained 33.1% of the association between RWSmax and LOCE(P=0.036).
Conclusions
Angiography-derived RWSmax identifies high-risk calcified nodules and predicts adverse outcomes. ECN is a significant mediator of the relationship between RWS and prognosis.RWSmax and Calcification-Related FeatureRWS, ECN and LOCE