Preintervention arterial remodeling as an independent predictor of target-lesion revascularization after nonstent coronary intervention - An analysis of 777 lesions with intravascular ultrasound imaging

Article

关键词: INADEQUATE COMPENSATORY ENLARGEMENT;    IN-VIVO;    ATHEROSCLEROSIS;    ANGIOPLASTY;    VALIDATION;    DISEASE;    INVIVO;    PLAQUE;   

DOI  :  10.1161/01.CIR.99.24.3149

来源: SCIE

【 摘 要 】

Background-Pathological and intravascular ultrasound (IVUS) studies have documented arterial remodeling during atherogenesis. However, the impact of this remodeling process on the long-term outcome after percutaneous intervention is unknown. Methods and Results-We used preintervention IVUS to define positive and negative/intermediate remodeling in a total of 777 lesions in 715 patients treated with nonstent techniques. Positive remodeling (lesion external elastic membrane area greater than average reference) was present in 313 lesions; intemediate/negative remodeling (lesion external elastic membrane area less than or equal to reference) was present in the other 464. Baseline clinical and angiographic characteristics were similar, except for a slightly higher percentage of insulin-dependent diabetic patients (10.2% versus 6.1%; P = 0.054) in the negative/intermediate-remodeling group. Angiographic success and in-hospital and short-term complications were comparable in the 2 groups. There was no significant correlation between remodeling (as a continuous variable) and final lumen area (r = 0.06) or final lesion plaque burden (r = 0.17), At 18 +/- 13 months of clinical follow-up, both groups had similar rates of death and Q-wave myocardial infarction: 3.4% and 2.5% for the negative/intermediate-remodeling group versus 2.7% and 2.7% for the positive-remodeling group. However, the target-lesion revascularization (TLR) rate was 20.2% for the negative/intermediate-remodeling group versus 31.2% for the positive-remodeling group (P = 0.007), and remodeling, as a continuous variable, was strongly correlated with probability of TLR (P = 0.0001). By multivariable logistic regression analysis, diabetes (OR = 2.3), left anterior descending artery location (OR = 1.8), and remodeling (OR = 5.9) were independent predictors of TLR. Conclusions-Positive lesion-site remodeling is associated with a higher long-term TLR after a nonstent interventional procedure. Thus, long-term clinical outcome appears to be determined in part by preintervention lesion characteristics.

【 授权许可】

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