Document Detail


Intravascular ultrasound assessment of optimal stent area to prevent in-stent restenosis after zotarolimus-, everolimus- and sirolimus-eluting stent implantation.
MedLine Citation:
PMID:  22815193     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES AND BACKGROUND: The impact of underexpansion and minimal stent area (MSA) criteria in the second generation drug-eluting stents (DES) has not been addressed yet. METHODS: Using intravascular ultrasound (IVUS), we assessed the optimal cut-off values of post-stenting MSA to prevent in-stent restenosis (ISR). Post-stenting IVUS data and 9-month follow-up angiography were available in 912 patients with 990 lesions: 541 sirolimus-eluting stents (SES), 220 zotarolimus-eluting stents (ZES) and 229 everolimus-eluting stents (EES). RESULTS: For the prediction of angiographic ISR, the MSA of each DES was measured. The post-stenting MSA was 6.4±1.8 mm(2) in SES, 6.2±2.1 mm(2) in ZES and 6.2±2.1 mm(2) in EES. At the 9-months follow-up, the incidence of angiographic ISR was similar between SES (3.3%) vs. ZES (4.5%) vs. EES. (4.4%), (p=0.53). Multivariable logistic regression analysis identified the post-stenting MSA as the only independent predictor of angiographic ISR in ZES (Odds ratio 0.722, 95% confidence interval 0.581-0.897, p=0.001) and in EES (Odds ratio 0.595, 95% confidence interval 0.392-0.904, p=0.015). The best MSA cut-off value was 5.5mm(2) for the prediction of SES restenosis (sensitivity 72.2% and specificity 66.3%). For ZES, the optimal MSA predicting ISR was 5.3mm(2) (sensitivity 56.7% and specificity 61.8%). For EES, the MSA <5.4mm(2) predicted ISR (sensitivity 60.0% and specificity 60.0%). CONCLUSIONS: As a preventable mechanism of ISR, smaller stent area predicted angiographic restenosis of the second generation DES as well as the first generation. The optimal cut-off values of post-stenting MSA for preventing restenosis were similar between ZES vs. EES vs. SES. © 2012 Wiley Periodicals, Inc.
Authors:
Hae-Geun Song; Soo-Jin Kang; Jung-Min Ahn; Won-Jang Kim; Jong-Young Lee; Duk-Woo Park; Seung-Whan Lee; Young-Hak Kim; Cheol Whan Lee; Seong-Wook Park; Seung-Jung Park
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-19
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Affiliation:
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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