| Relationship between angiographic late loss and target lesion revascularization after coronary stent implantation: analysis from the TAXUS-IV trial. | |
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MedLine Citation:
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PMID: 15837248 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to evaluate the relationship between angiographic late loss and clinical outcomes in the drug-eluting stent era. BACKGROUND: The interrelationship between angiographic late loss, binary restenosis, and clinical recurrence (target lesion revascularization [TLR]) after coronary stent implantation has been incompletely evaluated. METHODS: Using the angiographic substudy of the TAXUS-IV trial, in which 1,314 patients with de novo coronary lesions were randomized to either the paclitaxel-eluting TAXUS stent or to its bare-metal equivalent, we defined the relationship between in-stent and analysis segment late loss, the shape of the late loss histogram (variance and skewedness), and nine-month TLR. RESULTS: Late loss by several measures was closely related to TLR (area under the receiver-operator curve >0.90). For individual vessels of the size in this study (2.8 +/- 0.5 mm), the likelihood of TLR did not exceed 5% until analysis segment late loss was >0.5 mm, and did not exceed 10% until late loss was >0.65 mm. At greater late losses, the late loss TLR relationship was steep and nearly linear. For the overall patient cohort, the rate of TLR was related, however, not only to median late loss, but also to measures of its statistical distribution (TLR increased with lack of homogeneous biologic response [greater variance and greater right skewedness]). Similar relationships held for late loss measured within the confines of the stent itself. CONCLUSIONS: Coronary stents result in large lumens with "room" to accommodate up to approximately 0.5 to 0.65 mm of tissue (angiographic analysis segment late loss) before the likelihood of clinical restenosis (TLR) exceeds 5% to 10%. These data have important implications toward understanding the absolute and relative efficacy of drug-eluting stents. |
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Authors:
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Stephen G Ellis; Jeffrey J Popma; John M Lasala; Joerg J Koglin; David A Cox; James Hermiller; Charles O'shaughnessy; James Tift Mann; Mark Turco; Ronald Caputo; Patrick Bergin; Joel Greenberg; Gregg W Stone |
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Publication Detail:
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Type: Clinical Trial; Clinical Trial, Phase IV; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 45 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2005 Apr |
Date Detail:
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Created Date: 2005-04-19 Completed Date: 2005-05-12 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1193-200 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. elliss@ccf.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angina Pectoris
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therapy Antineoplastic Agents / administration & dosage* Area Under Curve Coronary Angiography Coronary Disease / therapy* Coronary Restenosis / prevention & control* Female Follow-Up Studies Humans Male Middle Aged Myocardial Revascularization Paclitaxel / administration & dosage* Recurrence Stents* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Antineoplastic Agents; 33069-62-4/Paclitaxel |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2005 Apr 19;45(8):1206-12
[PMID:
15837250
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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