Optical Coherence Tomography Factors for Adverse Events in Patients with Severe Coronary Calcification.

Background: Severe coronary calcification is a factor for worse outcomes after percutaneous coronary intervention. Aims: To identify factors of pre- and post-stent optical coherence tomography (OCT) for device-oriented clinical endpoints (DoCE) in patients with severely calcified lesions requiring drug-eluting stent (DES) implantation.Methods: A total of 237 consecutive patients with stable coronary disease who underwent OCT imaging of severe coronary lesions were included. Lesions with a maximum calcium angle >180 degrees, maximum calcium thickness > 0.5 mm, and calcium length > 5 mm were defined as having severe calcification.Results: The prevalence of eruptive calcified nodules (41% vs. 18%, p = 0.002) and medial dissection with calcified flaps (59% vs. 26%, p < 0.001) was significantly higher in patients with DoCE (n = 34) than those without DoCE (n = 203). Multivariate analyses demonstrated that the presence of a medial dissection with calcified flap within the DES-implanted segment was independently associated with a higher incidence of DoCE (odds ratio, 3.367; 95% confidence interval, 1.503-7.543; p = 0.003). The combined presence of eruptive calcified nodules and medial dissection with calcified flaps was associated with a higher incidence of DoCE (p < 0.001) during a median of 756 days after DES implantation.Conclusions: OCT-defined severely calcified lesions with eruptive calcified nodules and medial dissection with calcified flaps were associated with a higher incidence of DoCE after DES implantation.