Abstract 15409: The Need for Lesion-specific Stent Optimization Criteria in Intravascular Ultrasound-guided Intervention for Diffuse Long Coronary Lesions: An Individual Patient-level Pooled Analysis of Four Randomized Controlled Trials

• Published in: Circulation (New York, N.Y.) N.Y.), 2020-11, Vol.142 (Suppl_3 Suppl 3), p.A15409-A15409
• Main Authors: Kim, Daehoon, Kim, Byeong-Keuk, Lee, Seung-Jun, Hong, Sung-jin, Ahn, Chul-min, Kim, Jung-Sun, Ko, Young-Guk, Choi, Donghoon, Hong, Myeong-Ki, Jang, Yangsoo
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.142.suppl_3.15409

IntroductionAchieving stent optimization on intravascular ultrasound (IVUS) is associated with favorable clinical outcomes in new-generation drug-eluting stents (DESs) implantation. Little is known about the stent optimization criteria in lesion subsets assorted according to vessel size and lesion length. HypothesisWe hypothesized lesion-specific IVUS criteria could provide a better prediction for the outcomes after DES implantation for diffuse coronary lesions. MethodsFrom four randomized trials comparing IVUS and angiography guidance in long coronary lesions, a total of 1,194 patients who underwent IVUS-guided intervention with DESs ≥26 mm in length were included. Primary endpoint was a major adverse cardiac event (MACE), defined as a composite of cardiovascular death, myocardial infarction, target vessel revascularization, or stent thrombosis at 1 year following intervention. ResultsMACE occurred in 41 (3.4%) patients. Among possible combinations of absolute and relative expansion criteria, the combination best predicting MACE was minimal stent area (MSA) ≥5.4 mm2 or 80% of mean lumen area (MLA) (Youden index=0.250) in overall patients. In 2x2 factorial subgroup analyses, the MSA cutoff was 4.9 mm2 or 85% of MLA for shorter (