Key result
High RWSmax in deferred calcified lesions is linked to ~2.9-fold higher adverse events, mediated by eruptive nodules.
Why the study?
Coronary calcification types, particularly eruptive calcified nodules, are associated with adverse events, and angiography-derived radial wall strain offers a feasible alternative to assess plaque biomechanics. The association of radial wall strain with calcification subtypes and its prognostic role in coronary calcification remained to be explored.
Does angiography-derived maximum radial wall strain (RWSmax) identify high-risk calcified nodules and predict lesion-oriented composite endpoints in patients with deferred calcified coronary lesions?
Cohort (n=241)
Does angiography-derived maximum radial wall strain (RWSmax) identify high-risk calcified nodules and predict lesion-oriented composite endpoints in patients with deferred calcified coronary lesions?
Angiography-derived maximum radial wall strain (RWSmax) independently identifies high-risk eruptive calcified nodules and predicts adverse clinical outcomes in deferred calcified coronary lesions.
Background and aims Coronary calcification types, particularly eruptive calcified nodules (ECN) are associated with adverse events. Angiography-derived radial wall strain (RWS) offers a feasible alternative to assess plaque biomechanics. This study aimed to explore the association of RWS with calcification subtypes and its prognostic role in coronary calcification. Methods In 241 patients with 258 deferred calcified lesions, The maximum RWS (RWSmax) was quantified from angiography using AngioPlus software. Calcification types (ECN, nodular calcification [NC], superficial calcific sheet [SCS]) were classified by optical coherence tomography. The primary endpoint was lesion-oriented composite endpoint (LOCE: cardiac death, target vessel MI, or clinically driven revascularisation) with median 1.5-year follow-up. Results Among 258 lesions, 43 (16.7%) were ECN, 26 (10.1%) were NC, and 189 (73.3%) were SCS. RWSmax was significantly higher in ECN than in NC and SCS (13.8% vs 10.6% vs 8.2%, P<0.001). RWSmax independently predicted ECN (adjusted OR = 1.46, 95% CI 1.26–1.70, P<0.001) with an area under the curve of 0.817 (95% CI 0.752–0.881, P<0.001). RWSmax ≥11% correlated with adverse morphological features: higher eccentricity (P<0.001), and more calcium with attenuation (P=0.017). Lesions with RWSmax≥11% had a higher LOCE risk (adjusted HR=2.91, 95%CI:1.03–8.27, P=0.044) . Mediation analysis showed ECN explained 33.1% of the association between RWSmax and LOCE(P=0.036). Conclusions Angiography-derived RWSmax identifies high-risk calcified nodules and predicts adverse outcomes. ECN is a significant mediator of the relationship between RWS and prognosis.
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Yan et al. (2026) conducted a cohort in Coronary calcification (deferred calcified lesions) (n=241). Maximum angiography-derived radial wall strain (RWSmax ≥11%) vs. RWSmax <11% was evaluated on Lesion-oriented composite endpoint (LOCE: cardiac death, target vessel MI, or clinically driven revascularisation) (adjusted HR 2.91, 95% CI 1.03-8.27, p=0.044). Angiography-derived RWSmax ≥11% in deferred calcified lesions predicted a higher risk of lesion-oriented adverse events (adjusted HR 2.91; 95% CI 1.03–8.27; P=0.044), mediated by eruptive nodules.
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