Key result
Mid-RCA location is linked to ~18.5-fold higher odds of eruptive calcified nodules.
Why the study?
Eruptive and non-eruptive calcified nodules are associated with different clinical outcomes following stenting, yet their distinct pathological and topographical characteristics remain poorly understood.
Observational (n=64)
Eruptive calcified nodules are independently associated with hemodialysis, mid-right coronary artery location, higher OCT-derived calcium burden, and larger adjacent lipid components on NIRS-IVUS compared to non-eruptive calcified nodules, which may aid in risk stratification during PCI.
Background Calcified nodules (CNs) are classified into eruptive and non-eruptive subtypes, which are associated with different clinical outcomes following stenting. However, their distinct pathological and topographical characteristics remain poorly understood. Methods We compared clinical and multimodality imaging characteristics of eruptive and non-eruptive CNs in patients undergoing percutaneous coronary intervention (PCI). The analysis included pre-procedural intracoronary imaging with optical coherence tomography (OCT) and near-infrared spectroscopy–intravascular ultrasound (NIRS-IVUS). NIRS-IVUS was used to measure the maximum 4-mm lipid core burden index (maxLCBI4mm) at the CN site. Results We identified 70 CNs (31 eruptive, 39 non-eruptive) in 64 patients. OCT-derived calcium angle and thickness were greater, calcium length were longer, NIRS-derived maxLCBI4mm were higher in lesions with eruptive CN. Topographically, eruptive CNs clustered in the mid-right coronary artery (RCA) and proximal left anterior descending artery, whereas non-eruptive CNs were distributed homogeneously throughout the coronary tree. Multivariable logistic regression analysis identified hemodialysis (odds ratio [OR] 6.19, 95% confidence interval [CI] 1.28-29.9, P=0.02), RCA-mid segment location (OR 18.5, 95% CI 1.24-275.6, P=0.03), OCT-derived high calcium score (OR 7.46, 95% CI 1.10-50.6, P=0.04) and maxLCBI4mm (OR 1.01, 95% CI 1.00-1.01, P<0.01) as independent predictors of eruptive CNs. Conclusion Eruptive and non-eruptive CNs exhibit distinct imaging phenotypes and topographical distributions. Eruptive CNs are characterized by a greater calcium burden, a larger adjacent lipid component, and a predilection for specific biomechanically stressed locations. These findings suggest different underlying pathophysiological mechanisms and may enhance risk stratification for complex calcified lesions.
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Usui et al. (2026) conducted an observational in Calcified nodules in coronary artery disease (n=64). Eruptive calcified nodules vs. Non-eruptive calcified nodules was evaluated on Presence of eruptive calcified nodules (associated with RCA-mid segment location) (OR 18.5, 95% CI 1.24-275.6, p=0.03). Eruptive calcified nodules were independently predicted by hemodialysis (OR 6.19), mid-RCA location (OR 18.5), high OCT calcium score (OR 7.46), and maxLCBI4mm (OR 1.01; all P<0.05).
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