title: Prevalence, distribution, predictors, and outcomes of patients with calcified nodules in native coronary arteries: a 3-vessel intravascular ultrasound analysis from Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT).
abstract: BACKGROUND
  Pathological studies suggest that calcified coronary nodules are a rare cause of thrombotic events. The frequency, distribution, predictors, and outcomes of calcified nodules have never been described.
  
  
  RESULTS
  After successful stenting in 697 patients (167 female; median age, 58.1 years) with acute coronary syndromes, 3-vessel gray-scale and virtual histology intravascular ultrasound was performed in the proximal-mid segments of all 3 coronary arteries as part of a prospective, multicenter study. On the basis of recent histological validation, an independent core laboratory identified calcified nodules as distinct calcification with an irregular, protruding, and convex luminal surface. Patients were followed up for 3 years (median). Overall, 314 calcified nodules were detected in 250 of 1573 analyzable arteries (185 of 623 patients). Thus, the prevalence of calcified nodules was 17% per artery and 30% per patient. Two or more calcified nodules were detected in 48 coronary arteries (3%) in 76 patients (12%). The calcified nodules were located <40 mm from the ostium of the coronary artery in 85% of left anterior descending arteries and 86% of left circumflex arteries, whereas calcified nodules within the right coronary arteries were evenly and more distally distributed. Patients with calcified nodules were significantly older and had more plaque volume, more thick-cap fibroatheroma, but fewer nonculprit lesion major adverse events on follow-up.
  
  
  CONCLUSIONS
  Calcified nodules in untreated nonculprit coronary segments in patients with acute coronary syndromes were more prevalent than previously recognized. Although their distribution mirrored the origin of most thrombotic events, calcified nodules caused fewer major adverse events during 3 years of follow-up.
authors: Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY 10022, USA.
authors: Yingjia
authors: Y
authors: Xu
authors: Gary S
authors: GS
authors: Mintz
authors: Anthony
authors: A
authors: Tam
authors: John A
authors: JA
authors: McPherson
authors: Andrés
authors: A
authors: Iñiguez
authors: Jean
authors: J
authors: Fajadet
authors: Martin
authors: M
authors: Fahy
authors: Giora
authors: G
authors: Weisz
authors: Bernard
authors: B
authors: De Bruyne
authors: Patrick W
authors: PW
authors: Serruys
authors: Gregg W
authors: GW
authors: Stone
authors: Akiko
authors: A
authors: Maehara
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000368:Aged; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D018084:Ultrasonography, Interventional; D014481:United States