The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Outcomes of stent optimisation in intravascular ultrasound-guided intervention for long or chronic totally occluded coronary lesions

DOI: 10.4244/EIJ-D-19-00762

1. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
2. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medince, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea, Korea, Republic Of
3. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
4. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea;
5. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; bCardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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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.

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