{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T21:44:38Z","timestamp":1785188678900,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,4,7]],"date-time":"2020-04-07T00:00:00Z","timestamp":1586217600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We sought to evaluate the incidence and clinical impact of calcified nodule (CN) in patients with heavily calcified lesions requiring rotational atherectomy (RA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>It remains unclear whether CN impacts adversely on clinical outcomes in patients with heavily calcified lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2011 and February 2014, 264 patients after second\u2010generation drug\u2010eluting stent (DES) implantation following RA were retrospectively enrolled. CN was defined as a convex shape of the luminal side of calcium as assessed by intravascular ultrasound. The primary endpoint was the cumulative 5\u2010year incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, clinically driven target lesion revascularization (CDTLR), and definite stent thrombosis (ST).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CN was observed in 128 patients (48.5%) with heavily calcified lesions. Cumulative 5\u2010year incidence of MACE was significantly higher in the CN group than in the non\u2010CN group, mainly driven by a higher rate of CDTLR and ST (35.4% vs. 18.8%, <jats:italic>p<\/jats:italic> &lt;\u2009.001; 23.2% vs. 7.9%, <jats:italic>p<\/jats:italic> &lt;\u2009.001; 7.0% vs. 0.93%, <jats:italic>p<\/jats:italic> =\u2009.009, respectively). Independent risk factors of 5\u2010year MACE included hemodialysis (hazard ratio [HR] =\u20093.39, 95% confidence intervals [CI]: 2.00\u20135.73, <jats:italic>p<\/jats:italic> &lt;\u2009.001), CN (HR = 2.53, 95% CI: 1.49\u20134.27, <jats:italic>p<\/jats:italic> &lt;\u2009.001), ostial lesion (HR = 3.02, 95% CI: 1.58\u20135.78, <jats:italic>p<\/jats:italic> =\u2009.001), left ventricular ejection fraction \u226440% (HR = 2.17, 95% CI: 1.27\u20133.70, <jats:italic>p<\/jats:italic> =\u2009.005), and right coronary artery lesion (HR = 1.82, 95% CI: 1.07\u20133.11, <jats:italic>p<\/jats:italic> =\u2009.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CN was observed in 48.5% of heavily calcified lesions, resulting in unfavorable long\u2010term clinical outcomes after second\u2010generation DES implantation following RA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.28896","type":"journal-article","created":{"date-parts":[[2020,4,7]],"date-time":"2020-04-07T16:09:05Z","timestamp":1586275745000},"page":"10-19","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Clinical impact of calcified nodule in patients with heavily calcified lesions requiring rotational atherectomy"],"prefix":"10.1002","volume":"97","author":[{"given":"Toru","family":"Morofuji","sequence":"first","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9927-9686","authenticated-orcid":false,"given":"Shoichi","family":"Kuramitsu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu 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Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Hyodo","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Shirai","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu 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