Cardiovascular Intervention and Therapeutics

, Volume 29, Issue 4, pp 315–323 | Cite as

Coronary artery calcification as a new predictor of non-target lesion revascularization during the chronic phase after successful percutaneous coronary intervention

  • Yohsuke Honda
  • Takuji Toyama
  • Yusuke Miyaishi
  • Hakuken Kan
  • Ren Kawaguchi
  • Hitoshi Adachi
  • Hiroshi Hoshizaki
  • Shigeru Oshima
Original Article


In the drug-eluting stent era, the outcome of patients undergoing percutaneous coronary intervention (PCI) has remarkably improved. Nevertheless, non-target lesion revascularization (non-TLR) is often performed even after successful PCI and optimized medical therapy. This study aimed to determine the predictor of non-TLR. In all, 125 consecutive patients with stable angina pectoris underwent intravascular ultrasound (IVUS)-guided PCI and were followed up for 3.3 ± 0.5 years. We performed oral glucose-tolerance tests in patients with no history of known diabetes mellitus (DM) to investigate glucose tolerance. To evaluate the severity of coronary artery calcification (CAC), we calculated CAC score by multiplying the arc (degree) with the length (mm) of the superficial calcium deposit detected by IVUS. Fourteen patients underwent non-TLR (non-TLR group); the remaining 111 did not (reference group). Glycosylated hemoglobin (HbA1c; %) and prevalence of known DM were similar in both groups, but the non-TLR group had higher fasting blood glucose (103 ± 16 vs. 94 ± 11 mg/dl, p = 0.04) and blood glucose (196 ± 60 vs. 149 ± 48 μU/ml, p = 0.01) and insulin at 2 h (184 ± 241 vs. 67 ± 49 μU/ml, p < 0.01) than did the reference group. CAC score was significantly higher in the non-TLR group (788 ± 585 vs. 403 ± 466, p = 0.01). Multiple logistic analysis indicated that CAC score is an independent predictor of non-TLR (p = 0.008). Non-TLR-free rate was significantly higher for patients with CAC score ≥400 than for those with CAC score <400 (p = 0.01). Non-TLR is associated with abnormal glucose tolerance and CAC score; CAC score is an independent predictor of non-TLR. Secondary prevention is especially important in patients with high CAC scores.


Coronary artery calcification Non-target lesion revascularization Abnormal glucose tolerance 


Conflict of interest



  1. 1.
    Gill EJ. Does statin therapy affect the progression of atherosclerosis measured by a coronary calcium score? Curr Atheroscler Rep. 2010;12:83–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Burke AP, Weber DK, Kolodgie FD, Farb A, Taylor AJ, Virmani R. Pathophysiology of calcium deposition in coronary arteries. Herz. 2001;26:239–44.PubMedCrossRefGoogle Scholar
  3. 3.
    Kataoka Y, Wolski K, Uno K, Puri R, Tuzcu EM, Nissen SE, et al. Spotty calcification as a marker of accelerated progression of coronary atherosclerosis: insights from serial intravascular ultrasound. J Am Coll Cardiol. 2012;59(18):1592–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Schmermund A, Baumgart D, Görge G, Seibel R, Grönemeyer D, Ge J, et al. Coronary artery calcium in acute coronary syndromes: a comparative study of electron-beam computed tomography, coronary angiography, and intracoronary ultrasound in survivors of acute myocardial infarction and unstable angina. Circulation. 1997;96:1461–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Mintz GS, Pichard AD, Popma JJ, Kent KM, Satler LF, Bucher TA, et al. Determinants and correlates of target lesion calcium in coronary artery disease: a clinical, angiographic and intravascular ultrasound study. J Am Coll Cardiol. 1997;29:268–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Baumgart D, Schmermund A, Goerge G, Haude M, Ge J, Adamzik M, et al. Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol. 1997;30:57–64.PubMedCrossRefGoogle Scholar
  7. 7.
    Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study. Circulation. 1995;92:2157–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using non-decalcifying methodology. J Am Coll Cardiol. 1998;31:126–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Mautner SL, Mautner GC, Froehlich J, Feuerstein IM, Proschan MA, Roberts WC, et al. Coronary artery disease: prediction with in vitro electron beam CT. Radiology. 1994;192:625–30.PubMedCrossRefGoogle Scholar
  10. 10.
    Keelan PC, Bielak LF, Ashai K, Jamjoum LS, Denktas AE, Rumberger JA, et al. Long-term prognostic value of coronary calcification detected by electron-beam computed tomography in patients undergoing coronary angiography. Circulation. 2001;104(4):412–7.PubMedCrossRefGoogle Scholar
  11. 11.
    O’Malley PG, Taylor AJ, Jackson JL, Doherty TM, Detrano RC. Prognostic value of coronary electron-beam computed tomography for coronary heart disease events in asymptomatic populations. Am J Cardiol. 2000;85:945–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Stone GW, Ellis SG, Cox DA, Hermiller J, O’Shaughnessy C, Mann JT, TAXUS-IV Investigators, et al. A polymer-based, paclitaxeleluting stent in patients with coronary artery disease. N Engl J Med. 2004;350:221–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Budoff MJ, Gul KM. Expert review on coronary calcium. Vasc Health Risk Manag. 2008;4:315–24.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Wang X, Lu C, Chen X, Zhao X, Xia D. A new method to quantify coronary calcification by intravascular ultrasound—the different patterns of calcification of acute myocardial infarction, unstable angina pectoris and stable angina pectoris. J Invasive Cardiol. 2008;20(11):587–90.PubMedGoogle Scholar
  15. 15.
    Fujii N, Asano R, Nagayama M, Tobaru T, Misu K, Hasumi E, et al. Long-term outcome of first-generation metallic coronary stent implantation in patients with coronary artery disease: observational study over a decade. Circ J. 2007;71(9):1360–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Kuramitsu S, Yokoi H, Domei T, Nomura A, Watanabe H, Yamaji K, et al. Impact of post-challenge hyperglycemia on clinical outcomes in Japanese patients with stable angina undergoing percutaneous coronary intervention. Cardiovasc Diabetol. 2013;12:74.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Beckman JA, Ganz J, Creager MA, Ganz P, Kinlay S. Relationship of clinical presentation and calcification of culprit coronary artery stenosis. Arterioscler Thromb Vasc Biol. 2001;21:1618–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Rasheed Q, Nair R, Sheehan H, Hodgson JM. Correlation of intracoronary ultrasound plaque characteristics in atherosclerotic coronary artery disease patients with clinical variables. Am J Cardiol. 1994;73:753–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Ehara S, Kobayashi Y, Kataoka T, Yoshiyama M, Ueda M, Yoshikawa J. Quantification of coronary calcification by intravascular ultrasound. Circ J. 2007;71:530–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D, et al. Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction. Circulation. 2004;110:3424–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Mintz GS, Popma JJ, Pichard AD, Kent KM, Satler LF, Chuang YC, et al. Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation. 1995;91:1959–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Vengrenyuk Y, Carlier S, Xanthos S, Cardoso L, Ganatos P, Virmani R, et al. A hypothesis for vulnerable plaque rupture due to stress-induced debonding around cellular microcalcification in thin fibrous cap. Proc Natl Acad Sci USA. 2006;103:14678–83.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Bangalore S, Kumar S, Fusaro M, Amoroso N, Kirtane AJ, Byrne RA, et al. Outcomes with various drug eluting or bare metal stents in patients with diabetes mellitus: mixed treatment comparison analysis of 22,844 patient years of follow-up from randomized trials. BMJ. 2012;345:e5170.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Hu DY, Pan CY, Yu JM, for the China Heart Survey Group. The relationship between coronary artery disease an abnormal glucose regulation in China: the China Heart Survey. Eur Heart J. 2006;27:2573–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Mazurek M, Kowalczyk J, Lenarczyk R, Zielinska T, Sedkowska A, Pruszkowska-Skrzep P, et al. The prognostic value of different glucose abnormalities in patients with acute myocardial infarction treated invasively. Cardiovasc Diabetol. 2012;28(11):78.CrossRefGoogle Scholar
  26. 26.
    Doerr R, Hoffmann U, Otter W, Heinemann L, Hunger-Battefeld W, Kulzer B, et al. Oral glucose tolerance test and HbA1c for diagnosis of diabetes in patients undergoing coronary angiography: [corrected] the Silent Diabetes Study. Diabetologia. 2011;54(11):2923–30.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2014

Authors and Affiliations

  • Yohsuke Honda
    • 1
  • Takuji Toyama
    • 1
  • Yusuke Miyaishi
    • 1
  • Hakuken Kan
    • 1
  • Ren Kawaguchi
    • 1
  • Hitoshi Adachi
    • 1
  • Hiroshi Hoshizaki
    • 1
  • Shigeru Oshima
    • 1
  1. 1.Gunma Prefectural Cardiovascular CenterMaebashiJapan

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