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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
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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. Post-intervention MSA of 5.3 mm2 or less was associated independently with a higher risk for TLR.

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

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

Received October 21, 2018

Received in revised form February 3, 2019

Accepted February 24, 2019

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