The Role of Calcified Nodules in Acute Coronary Syndrome: Diagnosis and Management

Calcified nodules (CNs) are increasingly recognized as critical contributors to the pathophysiology of acute coronary syndrome (ACS). This review provides a comprehensive synthesis of the recent literature, focusing on the prevalence of CNs, their underlying mechanisms, and their implications for the clinical management of coronary artery disease (CAD). CNs are characterized by unique pathophysiological processes, and the diagnosis and treatment of CNs during percutaneous coronary interventions (PCIs) underscore the importance of advanced intravascular imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), for precise identification and prognostic evaluation. Current therapeutic strategies aim to modulate CN characteristics, enhance arterial wall stability, and reduce the risk of ACS and sudden cardiac death. This review highlights the impact of CNs in ACS, the role of intravascular imaging in diagnosis, and the importance of targeted interventions to improve clinical outcomes, as by bridging diagnostic insights with emerging atherectomy modalities, this review also seeks to advance the understanding and management of CNs in PCI, fostering improved patient outcomes.