Intravascular Imaging Predictors Associated With Cardiovascular Events After Complex PCIs.

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Joo Myung Lee, Sang Yoon Lee, Woochan Kwon, Seung-Jae Lee, Jong-Young Lee, Seung Hun Lee, Doosup Shin, Sang Yeub Lee, Sang Min Kim, Kyeong Ho Yun, Jae Young Cho, Chan Joon Kim, Hyo-Suk Ahn, Chang-Wook Nam, Hyuck-Jun Yoon, Yong Hwan Park, Wang Soo Lee, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Young Bin Song, Joo-Yong Hahn
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引用次数: 0

Abstract

Background: Intravascular imaging-guided percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes in patients with complex coronary artery lesions compared with angiography-guided PCI. However, the prognostic impact of suboptimal findings on intravascular imaging such as stent underexpansion, malapposition, or dissection is unclear in the era of contemporary drug-eluting stents.

Methods: From RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) which compared imaging-guided PCI with angiography-guided PCI in patients with complex lesions, post-PCI intravascular imaging findings, including minimum stent area (MSA), relative stent underexpansion (MSA≤80% of the average reference lumen area), malapposition, or dissection, were assessed in nonleft main target lesions. The primary end point was target lesion failure (TLF), a composite of cardiac death, target lesion-related myocardial infarction, target lesion revascularization, or definite stent thrombosis.

Results: A total of 897 nonleft main lesions from 714 patients undergoing imaging-guided PCI were included. During a median follow-up duration of 2.1 years, the optimal cutoff value of MSA to predict the occurrence of TLF was 5.5 mm2, and MSA<5.5 mm2 was associated with a significantly higher risk of TLF than MSA≥5.5 mm2 (2.2% versus 4.8%; adjusted hazard ratio, 3.09 [95% CI, 1.01-9.50]; P=0.048). Compared with the reference group (MSA≥5.5 mm2 and no suboptimal findings), the subgroup of patients with MSA≥5.5 mm2 and post-PCI intravascular imaging findings of relative stent underexpansion, major malapposition, or major dissection was associated with a numerically increased risk of TLF (0.0% versus 3.2%; P=0.057). Compared with the same reference group, the subgroup of patients with MSA<5.5 mm2 and suboptimal post-PCI intravascular imaging findings was associated with a significantly increased risk of TLF (0.0% versus 4.7%; P=0.017).

Conclusions: After intravascular imaging-guided PCI with contemporary drug-eluting stents for nonleft main complex lesions, inadequate absolute stent expansion was independently associated with a higher risk of TLF. Suboptimal post-PCI intravascular imaging findings of relative stent underexpansion, major malapposition, and major dissection seem to contribute to the risk of TLF.

Registration: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.

复杂pci后与心血管事件相关的血管内影像学预测因子。
背景:与血管造影引导下的PCI相比,血管内成像引导下的经皮冠状动脉介入治疗(PCI)已被证明可以改善复杂冠状动脉病变患者的临床结果。然而,在当代药物洗脱支架时代,血管内成像的次优结果(如支架扩张不足、错位或剥离)对预后的影响尚不清楚。方法:RENOVATE-COMPLEX-PCI(血管内成像指导与血管造影指导复杂经皮冠状动脉介入治疗后临床结果的随机对照试验)比较了复杂病变患者在成像指导下的PCI与血管造影指导下的PCI, PCI后血管内成像结果,包括最小支架面积(MSA),相对支架扩张不足(MSA≤平均参考管腔面积的80%),错置或夹层,在非左主靶病变中进行评估。主要终点是靶病变失败(TLF),心脏死亡、靶病变相关心肌梗死、靶病变血运重建或明确的支架血栓形成的综合结果。结果:714例行影像引导下PCI的患者共897个非左主干病变。在中位随访2.1年期间,MSA预测TLF发生的最佳临界值为5.5 mm2, MSA2与TLF发生的风险显著高于MSA≥5.5 mm2 (2.2% vs 4.8%;校正风险比,3.09 [95% CI, 1.01-9.50];P = 0.048)。与对照组(MSA≥5.5 mm2且无次优表现)相比,MSA≥5.5 mm2且pci后血管内影像学表现为相对支架扩张不足、主要错位或主要夹层的患者亚组与TLF的数值增加相关(0.0%对3.2%;P = 0.057)。与同一参照组相比,MSA2和pci后血管内成像结果不理想的患者亚组与TLF风险显著增加相关(0.0%对4.7%;P = 0.017)。结论:在血管内成像引导下PCI使用现代药物洗脱支架治疗非左主干复杂病变后,支架绝对扩张不充分与TLF的高风险独立相关。相对支架扩张不足、主要错位和主要夹层等pci后血管内成像结果不理想似乎会增加TLF的风险。注册:https://www.clinicaltrials.gov;唯一标识符:NCT03381872。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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