Author + information
- Akiko Fujino1,
- Gary Mintz1,
- Mitsuaki Matsumura1,
- Myong Hwa Yamamoto2,
- Cheolmin Lee1,
- Masahiro Hoshino3,
- Eisuke Usui3,
- Yoshihisa Kanaji4,
- Tadashi Murai3,
- Taishi Yonetsu3,
- Allen Jeremias5,
- Ziad Ali6,
- Fernando Sosa7,
- Elizabeth Haag8,
- Jeffrey Moses6,
- Richard Shlofmitz5,
- Tsunekazu Kakuta3 and
- Akiko Maehara1
- 1Cardiovascular Research Foundation, New York, New York, United States
- 2Cardiovascular Research Foundation, New York, United States
- 3Tsuchiura General Kyodo Hospital, Tsuchiura, Japan
- 4Tsuchiura kyoudou Hospital, Tsuchiura, Japan
- 5St. Francis Hospital, Roslyn, New York, United States
- 6NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 7Abbott Vascular, New York, New York, United States
- 8St Francis Hospital, Roslyn, New York, United States
We sought to develop and validate a new optical coherence tomography (OCT)-based calcium scoring system to predict stent underexpansion.
After excluding lesions treated with atherectomy or without any calcium, a calcium volume index (CVI) was developed using 128 pts with pre- and post-stent OCT (test cohort) and then validated in a second cohort of 138 pts.
In multivariable linear regression model using pts in the test cohort, independent predictors of stent expansion (minimum stent area/average of proximal and distal reference lumen area) were maximum calcium angle per 90 ° (regression coefficient, -6.20 [95% CI, -9.13, -3.27], p<0.01), maximum calcium thickness per 0.5mm (-3.46 [-6.28, -0.64], p=0.02), and calcium length per 5mm (-3.26 [-5.42, -1.1], p<0.01). CVI was then defined as 1 point for maximum angle >90°, but ≤180°; 2 points for calcium angle >180°; 1 point for maximum calcium thickness >0.5mm; and 1 point for calcium length >5mm. In the validation cohort, there was a step-wise decrease in stent expansion according to the CVI: mild calcium [score 0-1, n=50]: 103.1% vs. moderate calcium [score 2-3, n=65]: 86.8% vs. severe calcium [score 4, n=23]: 77.9%, p<0.01. Three calcium parameters could predict stent underexpansion (Figure). On multivariate analysis with adjusting for balloon size, pressure, and stent length, the CVI score was an independent predictor of stent underexpansion (regression coefficient; -7.16 (-9.14, -5.19, p<0.01).
OCT can quantify calcium (using a newly developed CVI) that can predict stent underexpansion.
IMAGING: Imaging: Intravascular