Clinical Outcomes Following Percutaneous Coronary Intervention with Drug-Eluting Stents and Drug-Coated Balloons in Lesion with Eruptive Calcified Nodules.

Abstract

Eruptive calcified nodules (ECN) represent a distinct and high-risk plaque morphology implicated in the pathogenesis of acute coronary syndrome. While prior studies have reported poor clinical outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) or drug-coated balloons (DCB) for these lesions, comparative data evaluating the efficacy of DES versus DCB therapy remains unavailable. Among 1,975 patients who underwent optical coherence tomography (OCT)-guided PCI for de novo coronary lesions, 68 patients (75 lesions) were identified with OCT-confirmed ECN. These lesions were retrospectively analyzed and stratified into either the DES group (45 lesions in 41 patients) or the DCB group (30 lesions in 27 patients). The primary endpoint was clinically driven target lesion revascularization (CD-TLR) and cardiac death. Over a median follow-up of 2.1 years, no significant differences were observed between the two groups in CD-TLR (hazard ratio [HR] 1.2; 95% confidence interval [CI] 0.5-3.2; p = 0.6) and cardiac death (HR 0.7; 95% CI 0.3-1.9; p = 0.5). These findings remained consistent after adjustment for baseline clinical characteristics. In conclusion, this study demonstrated that PCI with either DES or DCB for OCT-identified ECN results in similarly poor clinical outcomes, highlighting the limitations of current PCI devices for these rare, unstable lesions and emphasizing the need for alternative therapies.