Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.
JACC Cardiovasc Interv. 2021 Aug 9;14(15):1639-1650. doi: 10.1016/j.jcin.2021.05.019.
The aim of this study was to evaluate various stent expansion indexes to determine the best predictor of clinical outcomes.
Numerous intravascular ultrasound (IVUS) studies have shown minimum stent area (MSA) to be the most powerful predictor of future events.
ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, multicenter registry of 8,582 patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents. Native coronary artery lesions treated with IVUS-guided PCI with final analyzable IVUS were included. Ten stent expansion indexes (MSA, MSA/vessel area at MSA site, conventional stent expansion [MSA/average of proximal and distal reference luminal area], minimum stent expansion using Huo-Kassab or linear model accounting for vessel tapering, stent asymmetry [minimum/maximum stent diameter within the entire stent], stent eccentricity [smallest minimum/maximum stent diameter at a single slice within the stent], IVUS-XPL [Impact of intravascular Ultrasound Guidance on Outcomes of Xience Prime Stents in Long Lesions] criteria, ULTIMATE [Intravascular Ultrasound Guided Drug Eluting Stents Implantation in "All-Comers" Coronary Lesions] criteria, and ILUMIEN IV criteria) were evaluated for their associations with lesion-specific 2-year clinically driven target lesion revascularization (TLR) or definite stent thrombosis.
Overall, 2,140 lesions in 1,831 patients were included; final MSA measured 6.2 ± 2.4 mm. Among the 10 stent expansion indexes, only MSA/vessel area at the MSA site was independently associated with 2-year clinically driven TLR or definite stent thrombosis (hazard ratio: 0.77; 95% confidence interval: 0.59-0.99; P = 0.04) after adjusting for morphologic and procedural parameters.
In this IVUS-guided PCI cohort with excellent final MSA overall, stent/vessel area at the MSA site, an index of relative stent expansion, was superior to absolute MSA and other expansion indexes in predicting 2-year clinically driven TLR or definite stent thrombosis.
本研究旨在评估各种支架扩张指数，以确定预测临床结果的最佳指标。
许多血管内超声（IVUS）研究表明最小支架面积（MSA）是预测未来事件的最有力指标。
ADAPT-DES（药物洗脱支架双重抗血小板治疗评估）是一项前瞻性、多中心注册研究，共纳入 8582 例接受药物洗脱支架经皮冠状动脉介入治疗（PCI）的患者。本研究纳入了接受 IVUS 指导下 PCI 治疗的原生冠状动脉病变，且最终有可分析的 IVUS 结果。共评估了 10 种支架扩张指数（MSA、MSA 在 MSA 部位的血管面积、常规支架扩张[MSA/近端和远端参考管腔面积的平均值]、使用 Huo-Kassab 或线性模型最小支架扩张以考虑血管变细、支架不对称性[整个支架内最小/最大支架直径]、支架偏心性[支架内单个切片上最小/最大支架直径]、IVUS-XPL[血管内超声指导对 Xience Prime 支架在长病变中结局的影响]标准、ULTIMATE[所有患者冠状动脉病变的血管内超声指导药物洗脱支架植入]标准和 ILUMIEN IV 标准）与病变特异性 2 年临床驱动的靶病变血运重建（TLR）或明确的支架血栓形成之间的关系。
共纳入 1831 例患者的 2140 处病变，最终 MSA 测量值为 6.2±2.4mm。在这 10 种支架扩张指数中，只有 MSA 在 MSA 部位的血管面积与 2 年临床驱动的 TLR 或明确的支架血栓形成独立相关（风险比：0.77；95%置信区间：0.59-0.99；P=0.04），校正形态学和手术参数后。
在这项总体上具有良好最终 MSA 的 IVUS 指导下 PCI 队列中，支架/MSA 部位的血管面积，一个相对支架扩张的指标，在预测 2 年临床驱动的 TLR 或明确的支架血栓形成方面优于绝对 MSA 和其他扩张指数。
