Impact of Calcified Nodules on Clinical Outcomes in Hemodialysis Patients Undergoing Percutaneous Coronary Intervention

Calcified nodules (CNs) are associated with poor prognosis after percutaneous coronary intervention (PCI) and have been reported to occur more frequently in hemodialysis patients. However, their prognosis in hemodialysis patients undergoing PCI has not been fully elucidated. We aimed to investigate the prognosis of hemodialysis patients who underwent PCI for CNs using intravascular ultrasound (IVUS) and/or optical coherence tomography (OCT)/optical frequency domain imaging (OFDI). About 141 hemodialysis patients who underwent PCI between January 2020 and December 2021 were analyzed retrospectively in a single center. CNs are defined as heavily calcified plaques that protruding into lumen in a convex shape. MACE (a composite of cardiovascular death, target lesion related myocardial infarction, and target lesion revascularization) between CNs and Non-CNs at 1 year were compared. In the entire study population, the mean age was 69.3 ± 10.7 years, and 94 (77.0%) were male. At 1 year, the incidence of MACE following PCI was significantly higher in the CNs group (39.2% vs 9.9%, log-rank p <0.001), particularly for cardiovascular death (17.7% vs 4.2%, log-rank p = 0.009). After multivariate analysis adjusting for demographic characteristics, CNs remained independently associated with increased risk of MACE (adjusted hazard ratio: 4.93, 95% confidence interval 2.07 to 11.76; p <0.001). CNs were associated with a higher incidence of MACE and a higher cardiovascular death rate in hemodialysis patients who underwent PCI.