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Predictors for target lesion microcalcifications in patients with stable coronary artery disease: an optical coherence tomography study

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Abstract

Background

The minimal fibrous cap thickness overlying the necrotic lipid core as well as the presence of macrophages are established characteristics of coronary plaque vulnerability. Recently, the presence of microcalcifications has emerged as a novel feature of vulnerable lesions. However, clinical and plaque morphological predictors of microcalcifications are unknown.

Methods

In patients with stable coronary artery disease, analysis of plaque morphology (n = 112) was performed using optical coherence tomography prior to coronary intervention to assess predictors of microcalcifications.

Results

Microcalcifications were present in 21/112 (18.7%) lesions. Segments with microcalcifications showed a higher total number of calcifications per lesion (6.7 ± 3.0 vs. 3.2 ± 2.5, p < 0.001), a lower percent area stenosis (70.9 ± 11.1 vs. 76.2 ± 9.7%, p = 0.028), and a higher frequency of macrophage infiltration (66.7 vs. 37.4%, p = 0.014). In lesions with vs. without microcalcifications, macrophage infiltration was characterized by a wider macrophage angle (31.1° ± 34.4° vs. 13.7° ± 20.6°, p = 0.003), a higher macrophage index (105.6 ± 269.0 vs. 31.6 ± 66.5° mm, p = 0.020), and an increased frequency of calcium–macrophage co-localization (47.6 vs. 15.6%, p = 0.001). In multivariable logistic regression analysis, the total number of calcifications per lesion (OR 1.53, 95% CI 1.23–1.91, p < 0.001), average macrophage angle (OR 1.28 for 10°-variation, 95% CI 1.03–1.60, p = 0.024), and percent area stenosis (OR 0.59 for 10% increase, 95% CI 0.34–1.04, p = 0.070) were independent predictors for the presence of microcalcifications, whereas the latter did not reach statistical significance.

Conclusion

Microcalcifications are related to a less advanced stenosis severity and to extensive plaque inflammation, but not to clinical parameters. Our data may add to the understanding and role of microcalcifications in coronary artery lesions.

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Abbreviations

18F-NaF 18:

Sodium fluoride

ACS:

Acute coronary syndrome

CAD:

Coronary artery disease

CT:

Computed tomography

FCT:

Fibrous cap thickness

FFR:

Fractional flow reserve

IVUS:

Intravascular ultrasound

OCT:

Optical coherence tomography

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Author notes

  1. Sebastian Reith and Andrea Milzi have contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    Sebastian Reith, Andrea Milzi, Rosalia Dettori, Nikolaus Marx & Mathias Burgmaier

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  1. Sebastian Reith
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Correspondence to Sebastian Reith.

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Reith, S., Milzi, A., Dettori, R. et al. Predictors for target lesion microcalcifications in patients with stable coronary artery disease: an optical coherence tomography study. Clin Res Cardiol 107, 763–771 (2018). https://doi.org/10.1007/s00392-018-1243-1

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