Author + information
- Received April 12, 2000
- Revision received October 30, 2000
- Accepted December 6, 2000
- Published online March 15, 2001.
- Hiroyuki Okura, MD∗,
- Yoshihiro Morino, MD∗,
- Akio Oshima, MD∗,
- Motoya Hayase, MD∗,
- Michael R Ward, MD, PhD∗,
- Jeffrey J Popma, MD†,
- Richard E Kuntz, MD, MSc†,
- Heidi N Bonneau, RN, MS∗,
- Paul G Yock, MD∗ and
- Peter J Fitzgerald, MD, PhD∗,* ()
- ↵*Reprint requests and correspondence: Dr. Peter J. Fitzgerald, Center for Research in Cardiovascular Interventions, Stanford University Medical Center, 300 Pasteur Drive, H3554, Stanford, California 94305-5637
The study was done to elucidate the relationship between baseline arterial remodeling and clinical outcome following stenting.
The impact of preintervention arterial remodeling on subsequent vessel response and clinical outcome has been reported following nonstent coronary interventions. However, in stented segments, the impact of preintervention remodeling on clinical outcome has not been clarified.
Preintervention remodeling was assessed in 108 native coronary lesions by using intravascular ultrasound (IVUS). Positive remodeling (PR) was defined as vessel area (VA) at the target lesion greater than that of average reference segments. Intermediate or negative remodeling (IR/NR) was defined as VA at the target lesion less than or equal to that of average reference segment. Remodeling index expressed as a continuous variable was defined as VA at the target lesion site divided by that of average reference segments.
Positive remodeling was present in 59 (55%) and IR/NR in 49 (45%) lesions. Although final minimal stent areas were similar (7.76 ± 1.80 vs. 8.09 ± 1.90 mm2, p = 0.36), target vessel revascularization (TVR) rate at nine-month follow-up was significantly higher in the PR group (22.0% vs. 4.1%, p = 0.01). By multivariate logistic regression analysis, higher remodeling index was the only independent predictor of TVR (p = 0.02).
Lesions with PR before intervention appear to have a worse clinical outcome following IVUS-guided stenting. Intravascular ultrasound imaging before stenting may be helpful to stratify lesions at high risk for accelerated intimal proliferation.
☆ Dr. Okura was supported by the Foreign Cardiovascular Fellow Education Fund from Stanford University, Stanford, California. This study was supported in part by Johnson and Johnson (Interventional Systems, Warren, New Jersey).
- Received April 12, 2000.
- Revision received October 30, 2000.
- Accepted December 6, 2000.
- American College of Cardiology