A novel optical coherence tomography‑based calcium scoring system can predict the stent expansion of moderate and severe calcified lesions

Chang Hou; Linjian Yang; Zixuan Xue; Haimiao Lin; Yuliang Ma; Qi Li; Chuanfen Liu; Mingyu Lu; Hong Zhao; Jian Liu

doi:10.3892/etm.2022.11667

A novel optical coherence tomography‑based calcium scoring system can predict the stent expansion of moderate and severe calcified lesions

Exp Ther Med. 2022 Oct 24;24(6):731. doi: 10.3892/etm.2022.11667. eCollection 2022 Dec.

Authors

Chang Hou^{1

2}, Linjian Yang^{1

2}, Zixuan Xue^{1

2}, Haimiao Lin^{1

2}, Yuliang Ma^{1

2}, Qi Li^{1

2}, Chuanfen Liu^{1

2}, Mingyu Lu^{1

2}, Hong Zhao^{1

2}, Jian Liu^{1

2}

Affiliations

¹ Department of Cardiology, Peking University People's Hospital, Beijing 100044, P.R. China.
² Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing 100044, P.R. China.

Abstract

Coronary calcified lesions can exert serious effects on stent expansion. A calcium scoring system, based on optical coherence tomography (OCT), has been previously developed to identify relatively mild calcified lesions that would benefit from plaque modification procedures. Therefore, the present study aimed to establish a novel OCT-based scoring system to predict the stent expansion of moderate and severe calcified lesions. A total of 33 patients who underwent percutaneous coronary intervention (PCI; 34 calcified lesions were observed using coronary angiography) were retrospectively included in the present study. Coronary angiography and OCT images were subsequently reviewed and analyzed. Furthermore, a calcium scoring system was developed based on the results of multivariate analysis before the optimal threshold for the prediction of stent underexpansion in patients with moderate and severe calcified lesions was determined. The mean age of the patients was 67±10 years. The present analysis demonstrated that the final post-PCI median stent expansion was 70.74%, where stent underexpansion (defined as stent expansion <80%) was observed in 23 lesions. The mean maximum calcium arc, length and thickness, which were assessed using OCT, were found to be 230˚, 25.10 mm and 1.18 mm, respectively. A multivariate logistic regression model demonstrated that age and the maximum calcium arc were independent predictors of stent underexpansion. A novel calcium scoring system was thereafter established using the following formula: (0.16 x age) + (0.03 x maximum calcium arc) according to the β-coefficients in the multivariate analysis, with the optimal cut-off value for the prediction of stent underexpansion being 16.87. Receiver operating characteristic curve analysis demonstrated that this novel scoring system yielded a larger area under the curve value compared with that from a previous study's scoring system. Therefore, in conclusion, since the calcium scoring system of the present study based on age and the maximum calcium arc obtained from OCT was specifically developed in the subjects with moderate and severe calcified lesions, it may be more accurate in predicting the risk of stent underexpansion in these patients.

Keywords: calcified plaque; calcium score; optical coherence tomography; percutaneous coronary intervention; stent underexpansion.

Grants and funding

Funding: The present study was supported by the National Natural Science Foundation of China (grant no. 11832003 and 81970294) and Peking University People's Hospital Scientific Research Development Funds (grant no. RDL-2020-11).