Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Post-intervention minimal stent area as a predictor of target lesion revascularization after everolimus-eluting stent implantation for in-stent restenosis

a single-center observational study

Fujita, Takanaria; Takeda, Terukia; Hano, Yoshifumic; Takashima, Noriyukib; Yamaji, Masayukia; Sakaguchi, Tomokoa; Maeda, Keikoa; Mabuchi, Hiroshia; Murakami, Tomoyukia; Morimoto, Takeshid; Kimura, Takeshie

doi: 10.1097/MCA.0000000000000731
PCI
Buy

Background Everolimus-eluting stent (EES) is effective for treating in-stent restenosis (ISR). However, the long-term incidence of target lesion revascularization (TLR) is unknown. Further, the role of post-intervention minimal stent area (MSA) measured by intravascular ultrasound (IVUS) in TLR is unknown in this setting.

Patients and methods Overall, 223 ISR lesions (192 patients) that were treated with EES between 2010 and 2016 were analyzed retrospectively. Lesions were divided into two groups according to the post-intervention MSA [ ≤ 5.3 mm2: 72 lesions (67 patients), and > 5.3 mm2: 151 lesions (138 patients)]. The cut-off point was determined on the basis of receiver operating characteristic curve analysis.

Results The cumulative 5-year incidence of TLR was significantly higher in the group with MSA of 5.3 mm2 or less than in the group with MSA more than 5.3 mm2 (15.8 and 7.2%, P = 0.01). After adjusting for confounders, the excess risk of the group with MSA of 5.3 mm2 or less relative to the group with MSA more than 5.3 mm2 for TLR remained significant [hazard ratio: 3.07, 95% confidence interval (CI): 1.17–8.51, P = 0.02]. Using multivariate logistic regression analysis, we identified female sex (odds ratio: 2.39, 95% CI: 1.06–5.49, P = 0.04) and stent size of 3.0 mm or less (odds ratio: 13.43, 95% CI: 6.23–32.38, P < 0.0001) as independent predictors of MSA of 5.3 mm2 or less.

Conclusion EES implantation for ISR was associated with an acceptable rate of TLR through long-term follow-up. Postintervention MSA of 5.3 mm2 or less was associated independently with a higher risk for TLR.

The role of post-intervention minimal stent area (MSA) measured by intravascular ultrasound (IVUS) in target lesion revascularization (TLR) is unknown after stenting for in-stent restenosis (ISR). 223 ISR lesions treated with everolimus-eluting stents were analyzed retrospectively. Lesions were divided into 2 groups according to the postintervention MSA (≤5.3mm2: 72 lesions, and >5.3mm2: 151 lesions). The cut-off point was determined based on receiver operating characteristic curve analysis. The cumulative 5-year incidence of TLR was significantly higher in the MSA ≤5.3mm2 group than in the MSA >5.3mm2 group (15.8% and 7.2%, P=0.01). After adjusting for confounders, the excess risk of the MSA ≤5.3mm2 group relative to the MSA >;5.3mm2 group for TLR remained significant (HR: 3.07, 95% CI 1.17-8.51, P=0.02). Using multivariate logistic regression analysis, we identified female sex (OR 2.39, 95%CI 1.06-5.49, P=0.04) and stent size ≤3.0mm (OR 13.43, 95%CI 6.23-32.38, P<0.0001) as the independent predictors of MSA ≤5.3mm2.

Departments of aCardiovascular Medicine

bCardiovascular Surgery, Koto Memorial Hospital, Shiga

cDepartment of Cardiovascular Medicine, Midorigaoka Hospital, Osaka

dDepartment of Clinical Epidemiology, Hyogo College of Medicine, Hyogo

eDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Received 21 October 2019 Revised 3 February 2019 Accepted 24 February 2019

Correspondence to Takanari Fujita, MD, Department of Cardiovascular Medicine, Koto Memorial Hospital, 2-1 Hiramatsu-Cho, Higashiomi-Shi, Shiga 527-0134, Japan, Tel: +81 749 45 5000; fax: +81 749 45 5001; e-mail: takanari@kuhp.kyoto-u.ac.jp

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.