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(Circulation. 1999;100:1285-1290.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Prognostic Value of the Modified American College of Cardiology/American Heart Association Stenosis Morphology Classification for Long-Term Angiographic and Clinical Outcome After Coronary Stent Placement

Adnan Kastrati, MD; Albert Schömig, MD; Shpend Elezi, MD; Josef Dirschinger, MD; Julinda Mehilli, MD; Helmut Schühlen, MD; Rudolf Blasini, MD; Franz-Josef Neumann, MD

From the Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany.

Correspondence to Dr Adnan Kastrati, Deutsches Herzzentrum, Lazarettstraße 36, 80636 München, Germany. E-mail kastrati{at}dhm.mhn.de

Background—The modified American College of Cardiology/American Heart Association (ACC/AHA) lesion morphology criteria are predictive of early outcome after various coronary catheter interventions. Their potential prognostic value after stent implantation and, in particular, for restenosis and long-term clinical outcome has not been studied. We assessed the prognostic value of the modified ACC/AHA criteria for the long-term angiographic and clinical outcome of patients after coronary stenting.

Methods and Results—This study includes 2944 consecutive patients with symptomatic coronary artery disease treated with coronary stent placement. Modified ACC/AHA lesion morphology criteria were used to qualitatively assess the angiograms; type A and B1 lesions were categorized as simple, and type B2 and C lesions were designated complex. Primary end points were angiographic restenosis and 1-year event-free survival. Restenosis rate was 33.2% in complex lesions and 24.9% in simple lesions (P<0.001). It was 21.7% for type A, 26.3% for type B1, 33.7% for type B2, and 32.6% for type C lesions. One-year event-free survival was 75.6% for patients with complex lesions and 81.1% for patients with simple lesions (P<0.001). It was 85.2% for patients with type A, 79.4% for type B1, 75.9% for type B2, and 75.2% type C lesions. The higher risk for restenosis and an adverse outcome associated with complex lesions was also maintained after multivariate adjustment for other clinical and angiographic characteristics.

Conclusions—The modified ACC/AHA lesion morphology scheme has significant prognostic value for the outcome of patients after coronary stent placement. Lesion morphology is able to influence the restenosis process and thus the entire 1-year clinical course of these patients.

Key Words: stents • thrombosis • restenosis • lesion

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