AIMS: We sought to investigate the incidence, predictors, and clinical outcomes of stent optimisation on intravascular ultrasound (IVUS) in long coronary lesions treated with new-generation drug-eluting stents (DESs). METHODS AND RESULTS: From four randomised trials comparing IVUS and angiography guidance in long (≥26 mm) or chronic total occlusion coronary lesions, a total of 1,396 patients who underwent IVUS-guided intervention were classified into two groups (Stent-optimisation and Non-optimisation) according to optimisation criteria [minimal stent area (MSA) ≥5.5 mm2 or 80% of mean reference lumen area (MLA)]. Major adverse cardiac event (MACE) occurrence, defined as a composite of cardiac death, myocardial infarction, stent thrombosis, or target-vessel revascularisation, was compared. Stent optimisation was not met in 578 (41%) patients. Predictors of non-optimisation were older age, longer lesion length, and smaller stent diameter. MACE rate was significantly higher in the Non-optimisation vs. the Stent-optimisation group (4.8% vs. 1.9%, log-rank P=0.002; adjusted hazard ratio=2.95, 95% confidence interval=1.43-6.06). Among possible combinations of absolute and relative expansion criteria, the combination best predicting MACE was MSA ≥5.4 mm2 or 80% of MLA (Youden index=0.264). CONCLUSIONS: Achieving stent optimisation on IVUS evaluation was associated with favourable outcomes in IVUS-guided, new-generation DES implantation for long coronary lesions including CTO.
AIMS: We sought to investigate the incidence, predictors, and clinical outcomes of stent optimisation on intravascular ultrasound (IVUS) in long coronary lesions treated with new-generation drug-eluting stents (DESs). METHODS AND RESULTS: From four randomised trials comparing IVUS and angiography guidance in long (≥26 mm) or chronic total occlusion coronary lesions, a total of 1,396 patients who underwent IVUS-guided intervention were classified into two groups (Stent-optimisation and Non-optimisation) according to optimisation criteria [minimal stent area (MSA) ≥5.5 mm2 or 80% of mean reference lumen area (MLA)]. Major adverse cardiac event (MACE) occurrence, defined as a composite of cardiac death, myocardial infarction, stent thrombosis, or target-vessel revascularisation, was compared. Stent optimisation was not met in 578 (41%) patients. Predictors of non-optimisation were older age, longer lesion length, and smaller stent diameter. MACE rate was significantly higher in the Non-optimisation vs. the Stent-optimisation group (4.8% vs. 1.9%, log-rank P=0.002; adjusted hazard ratio=2.95, 95% confidence interval=1.43-6.06). Among possible combinations of absolute and relative expansion criteria, the combination best predicting MACE was MSA ≥5.4 mm2 or 80% of MLA (Youden index=0.264). CONCLUSIONS: Achieving stent optimisation on IVUS evaluation was associated with favourable outcomes in IVUS-guided, new-generation DES implantation for long coronary lesions including CTO.
Authors: Leszek Bryniarski; Maksymilian P Opolski; Jarosław Wójcik; Maciej Lesiak; Tomasz Pawłowski; Jakub Drozd; Wojciech Wojakowski; Sławomir Surowiec; Maciej Dąbrowski; Adam Witkowski; Dariusz Dudek; Marek Grygier; Stanisław Bartuś Journal: Postepy Kardiol Interwencyjnej Date: 2021-03-27 Impact factor: 1.426