Kobayashi Nobuaki, Mintz Gary S, Witzenbichler Bernhard, Metzger D Christopher, Rinaldi Michael J, Duffy Peter L, Weisz Giora, Stuckey Thomas D, Brodie Bruce R, Parvataneni Rupa, Kirtane Ajay J, Stone Gregg W, Maehara Akiko
From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
Circ Cardiovasc Interv. 2016 Jul;9(7):e003553. doi: 10.1161/CIRCINTERVENTIONS.115.003553.
Intravascular ultrasound detects stent edge dissections after percutaneous coronary intervention that are not seen angiographically. This study investigated the association between stent edge dissections and clinical outcomes.
ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a large-scale, prospective, multicenter study of patients undergoing drug-eluting stent implantation. In this prospective substudy, 2062 patients (2433 lesions) were evaluated with intravascular ultrasound to characterize the morphological features and clinical outcomes of stent edge dissection after percutaneous coronary intervention. The prevalence of post-percutaneous coronary intervention stent edge dissection was 6.6% per lesion (161 of 2433). Calcified plaque at the proximal stent edge (relative risk [RR]=1.72; P=0.04) and proximal stent edge expansion (RR=1.18; P=0.004) were predictors for proximal dissection; attenuated plaque at the distal stent edge (RR=3.52; P=0.004), distal reference plaque burden (RR=1.56; P<0.0001), and distal edge stent expansion (RR=1.11; P=0.02) were predictors for distal dissection. At 1-year follow-up, target lesion revascularization was more common in lesions with versus without dissection (5.2% versus 2.7%; P=0.04). Multivariable analysis indicated that residual dissection was associated with target lesion revascularization at 1-year follow-up (RR=2.67; P=0.02). Among lesions with dissection, smaller effective lumen area increased the risk of target lesion revascularization at 1-year follow-up (cutoff value of 5.1 mm(2); P=0.05).
Greater stent expansion and the presence of large, calcified, and/or attenuated plaques were independent predictors of stent edge dissection. Residual stent edge dissection, especially with a smaller effective lumen area, was associated with target lesion revascularization during 1-year follow-up after drug-eluting stent implantation.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
血管内超声可检测经皮冠状动脉介入治疗后血管造影未显示的支架边缘夹层。本研究调查了支架边缘夹层与临床结局之间的关联。
ADAPT-DES（药物洗脱支架双重抗血小板治疗评估）是一项对接受药物洗脱支架植入患者的大规模、前瞻性、多中心研究。在这项前瞻性子研究中，对2062例患者（2433处病变）进行血管内超声评估，以明确经皮冠状动脉介入治疗后支架边缘夹层的形态学特征和临床结局。经皮冠状动脉介入治疗后支架边缘夹层的患病率为每处病变6.6%（2433处病变中的161处）。近端支架边缘的钙化斑块（相对风险[RR]=1.72；P=0.04）和近端支架边缘扩张（RR=1.18；P=0.004）是近端夹层的预测因素；远端支架边缘的变薄斑块（RR=3.52；P=0.004）、远端参考斑块负荷（RR=1.56；P<0.0001）和远端边缘支架扩张（RR=1.11；P=0.02）是远端夹层的预测因素。在1年随访时，有夹层的病变比无夹层的病变更常发生靶病变血运重建（5.2%对2.7%；P=0.04）。多变量分析表明，残余夹层与1年随访时的靶病变血运重建相关（RR=2.67；P=0.02）。在有夹层的病变中，较小的有效管腔面积增加了1年随访时靶病变血运重建的风险（临界值为5.1 mm²；P=0.05）。
更大的支架扩张以及存在大的、钙化的和/或变薄的斑块是支架边缘夹层的独立预测因素。药物洗脱支架植入后1年随访期间，残余支架边缘夹层，尤其是有效管腔面积较小者，与靶病变血运重建相关。
Zotero 插件