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2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society Association of Plaque Location and Vessel Geometry Determined by Coronary Computed Tomographic Angiography With Future Acute Coronary Syndrome–Causing Culprit Lesions Screening for Atrial Fibrillation With ECG: USPSTF Recommendation Subclinical Atherosclerosis Burden by 3D Ultrasound in Mid-Life: The PESA Study Coronary Catheterization and Percutaneous Coronary Intervention in China: 10-Year Results From the China PEACE-Retrospective CathPCI Study Effect of improved door-to-balloon time on clinical outcomes in patients with ST segment elevation myocardial infarction Robotics in percutaneous cardiovascular interventions Long-Term Outcomes in Women and Men Following Percutaneous Coronary Intervention Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial Outcome of patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention during on- versus off-hours (a Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] trial substudy)

Original Research2018 Apr 6;13(18):e2182-e2189.

JOURNAL:EuroIntervention. Article Link

A new optical coherence tomography-based calcium scoring system to predict stent underexpansion

Fujino A, Mintz GS, Matsumura M et al. Keywords: calcified stenosis; OCT

ABSTRACT


AIMS - This was a retrospective study to develop and validate an optical coherence tomography (OCT)-based calcium scoring system to predict stent underexpansion.


METHODS AND RESULTS - A calcium score was developed using 128 patients with pre- and post-stent OCT (test cohort) and then validated in an external cohort of 133 patients. In the test cohort, a multivariable model showed that the independent predictors of stent expansion were maximum calcium angle per 180° (regression coefficient: -7.43; p<0.01), maximum calcium thickness per 0.5 mm (-3.40; p=0.02), and calcium length per 5 mm (-2.32; p=0.01). A calcium score was then defined as 2 points for maximum angle >180°, 1 point for maximum thickness >0.5 mm, and 1 point for length >5 mm. In the validation cohort, the lesions with calcium score of 0 to 3 had excellent stent expansion, whereas the lesions with a score of 4 had poor stent expansion (96% versus 78%, p<0.01). On multivariate analysis the calcium score was an independent predictor of stent underexpansion.

CONCLUSIONS - An OCT-based calcium scoring system can help to identify lesions that would benefit from plaque modification prior to stent implantation. Lesions with calcium deposit with maximum angle >180°, maximum thickness >0.5 mm, and length >5 mm may be at risk of stent underexpansion.