Association of coronary calcium arc on stent expansion in patients with non-ST elevation myocardial infarction by intravascular ultrasound

Badal Chandra Barman; Mir Jamal Uddin; Pradip Kumar Karmakar; Nur Alam; Gokul Chandra Datta; Mithun Saha; Shafiqul Islam

doi:10.18203/2320-6012.ijrms20251623

Authors

Badal Chandra Barman Department of Cardiology, National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh
Mir Jamal Uddin Department of Cardiology, National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh
Pradip Kumar Karmakar Department of Cardiology, National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh
Nur Alam Department of Cardiology, National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh
Gokul Chandra Datta Department of Cardiology, National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh
Mithun Saha Department of Cardiology, National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh
Shafiqul Islam Department of Cardiology, National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251623

Keywords:

Acute luminal diameter gain, Cardiovascular diseases, Stent length, Myocardial infarction, Coronary calcium, Luminal CSA gain

Abstract

Background: Coronary calcification indicates atherosclerotic plaque burden and contributes to stent under-expansion, leading to complications like restenosis and thrombosis. The impact of coronary calcium severity on stent expansion in NSTEMI patients remains unexplored in our population. This study aimed to evaluate the association between the coronary calcium arc and stent expansion in patients with non-ST elevation myocardial infarction (NSTEMI) using intravascular ultrasound (IVUS).

Methods: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from May 2019 to April 2020. A total of 109 NSTEMI patients undergoing IVUS-guided PCI for calcified lesions at NICVD were enrolled. Based on the calcium arc, 73 patients (0-180°) formed Group I, and 36 (181-270°) formed Group II. Stent expansion was measured. Ethical approval was obtained, and data were analyzed using SPSS version 23.0.

Results: In this study, despite higher balloon pressures in Group II, acute diameter gain (1.5±0.4 mm vs 1.4±0.3 mm, p<0.03), acute CSA gain (5.8±1.2 vs 5.3±1.0, p<0.04), stent expansion by MLD (95.6±2.9% vs 89.6±3.3%, p<0.001), and MLA (92.7±5.1% vs 81.3±6.4%, p<0.001) were lower than in Group I. Stent expansion correlated negatively with calcium arc (MLD: r=-0.66, p<0.001; MLA: r=-0.69, p<0.001) but not with calcium length (MLD: r=0.14, p=0.1; MLA: r=0.09, p=0.36).

Conclusion: Implantation of stents in calcified lesions results in less optimal stent expansion, especially in lesions with thick, eccentric calcific plaque layers.

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References

Moran AE, Roth GA, Narula J, Mensah GA. The global burden of cardiovascular diseases. Global Heart. 2014;9(1):19-51. DOI: https://doi.org/10.1016/j.gheart.2013.12.007

Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological. European Heart J. 2016;37(42):3232-45. DOI: https://doi.org/10.1093/eurheartj/ehw334

Update AS. Heart disease and stroke statistics–2017 update. Circulation. 2017;135:146-603.

Zipes DP. Braunwald's heart disease e-book: A textbook of cardiovascular medicine. Elsevier Health Sciences. 2018: 1181–1202.

Otsuka F, Sakakura K, Yahagi K, Joner M, Virmani R. Has our understanding of calcification in human coronary atherosclerosis progressed. Arteriosclerosis, Thromb Vasc Biol. 2014;34(4):724-36. DOI: https://doi.org/10.1161/ATVBAHA.113.302642

Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, Généreux P. Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol. 2014;63(17):1703-14. DOI: https://doi.org/10.1016/j.jacc.2014.01.017

Foin N, Lu S, Ng J, Bulluck H, Hausenloy DJ, Wong PE, et al. Stent malapposition and the risk of stent thrombosis: mechanistic insights from an in vitro model. Euro Intervention. 2017;13(9):1096-8. DOI: https://doi.org/10.4244/EIJ-D-17-00381

Alegría-Barrero E, Chan PH, Foin N, Syrseloudis D. Predictors of stent strut malapposition in calcified vessels using frequency-domain optical coherence tomography. J Invasive Cardiol. 2013;25(9):429-34.

Kobayashi Y, Okura H, Kume T. Imapact of target lesion coronary calcification on stent expansion–An optical coherence tomography study. Circulation J. 2014;78(9):2209-14. DOI: https://doi.org/10.1253/circj.CJ-14-0108

Mintz GS. Clinical utility of intravascular imaging and physiology in coronary artery disease. J Am Coll Cardiol. 2014;64(2):207-22. DOI: https://doi.org/10.1016/j.jacc.2014.01.015

Emile M. "Volumetric characterization of human coronary calcification by frequency-domain optical coherence tomography." Circulation J. 2013;9:2334-40. DOI: https://doi.org/10.1253/circj.CJ-12-1458

Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J American Coll Cardiol. 2012;59(12):1058-72. DOI: https://doi.org/10.1016/j.jacc.2011.09.079

Li Q, He Y, Chen L, Chen M. Intensive plaque modification with rotational atherectomy and cutting balloon before drug-eluting stent implantation for patients with severely calcified coronary lesions: a pilot clinical study. BMC Cardiovas Dis. 2016;16:1-9. DOI: https://doi.org/10.1186/s12872-016-0273-8

Pregowski J, Jastrzebski J, Kępka C, Kruk M. Relation between coronary plaque calcium deposits as described by computed tomography coronary angiography and acute results of stent deployment as assessed by intravascular ultrasound. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2013;9(2):115-20. DOI: https://doi.org/10.5114/pwki.2013.35444

Akanda MA, Ali SY, Islam AE, Rahman MM, Parveen A, Kabir MK, et al. Demographic profile, clinical presentation & angiographic findings in 637 patients with coronary heart disease. Faridpur Med Coll J. 2011;6(2):82-5. DOI: https://doi.org/10.3329/fmcj.v6i2.9206

Tao LC, Xu JN, Wang TT, Hua F, Li JJ. Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations. Cardiovas Diabetol. 2022;21(1):68. DOI: https://doi.org/10.1186/s12933-022-01511-x

Akhter A, Islam QN. Women and men in Bangladesh: facts and figures 2018. Bangladesh Bureau of Statistics (BBS). 2019.

Kalyoncuoglu M, Durmus G. Relationship between C-reactive protein-to-albumin ratio and the extent of coronary artery disease in patients with non-ST-elevated myocardial infarction. Cor Art Dis. 2020;31(2):130-6. DOI: https://doi.org/10.1097/MCA.0000000000000768

Karabağ Y, Çağdaş M, Rencuzogullari I, Karakoyun S. Relationship between C‐reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Labo Anal. 2018;32(7):22457. DOI: https://doi.org/10.1002/jcla.22457

Hoffmann R. "Treatment of calcified coronary lesions with Palmaz–Schatz stents: An intravascular ultrasound study." European Heart J. 1998;8:1224-31. DOI: https://doi.org/10.1053/euhj.1998.1028

Vavuranakis M, Toutouzas K, Stefanadis C, Chrisohou C, Markou D, Toutouzas P. Stent deployment in calcified lesions: Can we overcome calcific restraint with high‐pressure balloon inflations. Cath Cardiovasc Interv. 2001;52(2):164-72. DOI: https://doi.org/10.1002/1522-726X(200102)52:2<164::AID-CCD1041>3.0.CO;2-S