Intravascular Ultrasound Predictors for Edge Restenosis After Newer Generation Drug-Eluting Stent Implantation

• Published in: The American journal of cardiology 2013-05, Vol.111 (10), p.1408-1414
• Main Authors: Kang, Soo-Jin, MD, PhD, Cho, Young-Rak, MD, Park, Gyung-Min, MD, Ahn, Jung-Min, MD, Kim, Won-Jang, MD, Lee, Jong-Young, MD, Park, Duk-Woo, MD, PhD, Lee, Seung-Whan, MD, PhD, Kim, Young-Hak, MD, PhD, Lee, Cheol Whan, MD, PhD, Mintz, Gary S., MD, Park, Seong-Wook, MD, PhD, Park, Seung-Jung, MD, PhD
• Format: Article
• Language: English
• Subjects: Angioplasty; Cardiology; Cardiovascular; Coronary Angiography; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - epidemiology; Dissection; Drug delivery; Drug-Eluting Stents; Female; Follow-Up Studies; Heart attacks; Humans; Immunosuppressive Agents - pharmacology; Incidence; Ischemia; Kinases; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - surgery; Prosthesis Failure; Reproducibility of Results; Republic of Korea - epidemiology; Retrospective Studies; Sirolimus - analogs & derivatives; Sirolimus - pharmacology; Stents; Studies; Thrombosis; Time Factors; Ultrasonic imaging; Ultrasonography, Interventional - methods; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.01.288

The aim of the present study was to assess the intravascular ultrasound predictors for angiographic edge restenosis after newer generation drug-eluting stent implantation. A total of 820 patients (987 lesions) who underwent newer generation drug-eluting stent placement (236 Endeavor zotarolimus-eluting stents, 246 Resolute zotarolimus-eluting stents, and 505 everolimus-eluting stents) with 9 months of angiographic surveillance were enrolled. The post-stenting angiographic and intravascular ultrasound images of 1,668 reference segments (681 proximal and 987 distal) were analyzed. Overall, 37% of angiographically normal proximal reference segments and 21% of angiographically normal distal reference segments had plaque burden >50%. In the overall cohort of 1,668 reference segments, 47 (2.8%) had 9-month angiographic edge restenosis (diameter stenosis >50%). Edge restenosis was predicted by a post-stenting reference segment plaque burden >54.5% (sensitivity 81%, specificity 80%) and a reference segment minimum lumen area of 5.7 mm2 (sensitivity 72%, specificity 59%). The edge restenosis rate was 2.1% in the Endeavor zotarolimus-eluting stents, 2.4% in the Resolute zotarolimus-eluting stents, and 3.4% in the everolimus-eluting stents lesions (p = 0.311). The predictive cutoff of the reference plaque burden was 56.3% for Endeavor zotarolimus-eluting stents, 57.3% for Resolute zotarolimus-eluting stents, and 54.2% for everolimus-eluting stents. The criteria for residual plaque burden were similar between proximal and distal reference segments (56.4% vs 51.9%, respectively), but the minimum lumen area criteria were quite different (