Intravascular ultrasound predictors of angiographics restenosis in lesions treated with Palmaz-Schatz stents

Rainer Hoffmann, Gary S. Mintz, Roxana Mehran, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Wu Hongsheng, Martin B. Leon

Research output: Contribution to journalArticlepeer-review

277 Scopus citations

Abstract

Objectives. This study sought to evaluate the clinical procedural, preinterventional and postinterventional quantitative coronary angiographic (QCA) and intravascular (IVUS) predictors of restenosis after Palmaz-Schatz stent placement. Background. Although Palmaz-Schatz stent placement reduces restenosis compared with balloon angioplasty, in-stent restenosis remains a major clinical problem. Methods. QCA and IVUS studies were performed before and after intervention (after stent placement and high pressure adjunct balloon angioplasty) in 832 lesions in 291 patients treated with 476 Palmaz- Schatz stents for whom follow-up QCA data were available 5.5 ± 4.8 months (mean ± SD) later. Univariate and multivariate predictors of QCA restenosis (≤50% diameter stenosis at follow-up, follow-up percent diameter stenosis [DS] and follow-up minimal lumen diameter [MLD] were determined. Results. Three variables were the most consistent predictors of the follow-up angiographic findings: ostial lesion location, IVUS preinterventional lesion site plaque burden (plaque/total arterial area) and IVUS assessment of final lumen dimensions (whether final lumen area or final MLD). All three variables predicted both the primary (binary restenosis) and secondary (follow-up MLD and follow-up DS) end points. In addition, a number of variables predicted one or more but not all the end points: 1) restenosis (IVUS preinterventional lumen and arterial area); 2) follow-up DS (QCA lesion length); and 3) follow- up MLD (QCA lesion length and preinterventional MLD and DS and IVUS preinterventional lumen and arterial area). Conclusions. Ostial lesion location and IVUS preinterventional plaque burden and postinterventional lumen dimensions were the most consistent predictors of angiographic in- stent restenosis.

Original languageEnglish
Pages (from-to)43-49
Number of pages7
JournalJournal of the American College of Cardiology
Volume31
Issue number1
DOIs
StatePublished - Jan 1998
Externally publishedYes

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