Author + information
- Song-Yi Kim1,
- Gary Mintz2,
- Bernhard Witzenbichler3,
- Michael Rinaldi4,
- Ernest Mazzaferri Jr.5,
- Peter L. Duffy6,
- Bruce Brodie7,
- Yangbo Liu2,
- Ajay Jayant Kirtane8,
- Gregg Stone9 and
- Akiko Maehara2
- 1Cardiovascular research foundation, New York, New York, United States
- 2Cardiovascular Research Foundation, New York, New York, United States
- 3Helios Amper-Klinikum, Dachau, Germany
- 4Sanger Heart and Vascular Institute/Carolinas Medical Center, Charlotte, North Carolina, United States
- 5Ohio State University Medical Center, Columbus, Ohio, United States
- 6FirstHealth Cardiology Services, Pinehurst, North Carolina, United States
- 7LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, North Carolina, United States
- 8Columbia University / New York-Presbyterian Hospital, New York, New Jersey, United States
- 9Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
In the balloon angioplasty and bare metal stent eras, positive lesion remodeling predicted adverse events at follow-up after PCI. The impact of lesion remodeling on clinical outcomes in the DES era has not been reported.
ADAPT-DES was a prospective, multicenter, observational study of 8,582 consecutive pts who were treated successfully with DES. 706 pts had pre- and post-PCI grayscale and VH-intravascular ultrasound (IVUS) of 829 native coronary culprit lesions. The remodeling index (RI) was calculated as the vessel area at the minimum lumen site divided by the average of the proximal and distal reference segment vessel areas. Positive remodeling (PR) was defined as an RI >1, and intermediate/negative remodeling (IR/NR) as an RI ≤1. The primary endpoint was major adverse cardiac events (MACE; cardiac death, MI, or definite/probable stent thrombosis) at 2 years.
Mean pt age was 63.2±10.3 yrs, and 76% were male. Among clinical factors, only acute coronary syndrome (ACS) presentation was related to PR (Odd ratio [95% CI] = 1.66 [1.17, 2.37], p=0.005). Lesions with PR had greater plaque burden and more frequent plaque ruptures, while lesions with IR/NR showed more calcified thick cap fibroatheroma. IVUS guidance resulted in a similar minimal stent area in pts with PR vs IR/NR (Table); however, pts with PR showed a higher incidence of MACE, primarily due to more MI (both peri-PCI and during follow-up), but not more target lesion revascularization (TLR; 2.9% vs. 2.6%, p=0.82). In a propensity score-adjusted multivariable analysis, PR was an independent predictor of MI (Hazard ratio [95% CI] = 3.12 [1.08, 9.00], p=0.049).
|PR (n=355 lesions)||IR/NR (n=474 lesions)||p-value|
|Remodeling index||1.32 [1.28, 1.36]||0.78 [0.77, 0.80]||<0.0001|
|Plaque burden, %||79.9 [79.0, 80.7]||72.3 [71.2, 73.4]||<0.0001|
|Calcified thick cap fibroatheroma||15.5%||23.0%||0.006|
|Post minimum stent area, mm2||6.5 [6.2, 6.7]||6.5 [6.3, 6.8]||0.66|
|- Cardiac death||1.2%||0.8%||0.84|
|- Stent thrombosis (def/prob)||0.3%||0.2%||0.50|
In the DES era, lesion PR continues to be a marker of clinical instability pre-PCI (ACS presentation, greater plaque burden, and more frequent plaque rupture) and is a predictor of peri-procedural and follow-up MI. PR is unrelated to TLR after DES.
IMAGING: Imaging: Intravascular