Abstract 17597: Intravascular Ultrasound and Angiographic Predictors of 5-Year Target Lesion Revascularization: Very Long-Term Clinical Follow-Up of the SPIRIT III Trial
BACKGROUND: This study aimed to assess the hypothesis that intravascular ultrasound (IVUS) or angiographic parameters can predict very long-term target lesion revascularization (TLR) in de novo coronary lesions treated with everolimus-eluting stents.
METHODS: In the IVUS cohort of the SPIRIT III trial, 202 lesions treated with everolimus-eluting stents underwent long-term clinical follow-up up to 5 years. Volume index (VI: volume/length, mm3/mm) was measured by IVUS. Cross-sectional narrowing was obtained as neointimal area/stent area (%CSN).
RESULTS: Overall, TLR occurred in 18 lesions (8.9%) within 8 months after the implantation, and additional 9 lesions (4.5%) received late-TLR between 8 months and 5 years (1192±415 days). Baseline clinical demographics were similar between the TLR and no-TLR patients. The early-TLR events were associated with smaller stent VI and vessel VI at post-procedure IVUS, as well as smaller minimum lumen diameter (MLD) and larger diameter stenosis (%DS) at post-procedure angiography. In contrast, these baseline morphometric parameters did not well predict the late-TLR events, except for smaller final MLD. Among the 8-month IVUS parameters, max %CSN, Δ vessel VI and Δ peri-stent plaque VI (from baseline to 8 months) were significantly greater in the late-TLR versus no-TLR lesions, while 8-month lumen dimensions were not statistically different between the 2 groups. No angiographic parameters at 8 months predicted the late-TLR events, including reference diameter, MLD, %DS, and late lumen loss (from baseline to 8 months).
CONCLUSIONS: Unlike early-TLR events that can reasonably be predicted by vessel size and stent morphometry at baseline, the determinants of late-TLR events appear to be related to temporal changes of the stented vessel (i.e., neointimal proliferation and vessel remodeling as assessed by IVUS) observed during the first 8 months, rather than simple lumen dimensions either at baseline or 8 months.
- Drug eluting stents
- Intravascular ultrasound/Doppler
- Interventional cardiology
- Cardiovascular imaging
- © 2012 by American Heart Association, Inc.