JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B 2012 Vol.13 No.8 P.624-630

http://doi.org/10.1631/jzus.B1201002

Value of a new post-procedural intravascular ultrasound score in predicting target vessel revascularization after coronary drug-eluting stents implantation

Author(s): Kai Xu, Ya-ling Han, Quan-min Jing, Shou-li Wang, Ying-yan Ma, Xiao-zeng Wang, Geng Wang, Zu-lu Wang
Affiliation(s): Department of Cardiology, Shenyang Northern Hospital, Shenyang 110016, China
Corresponding email(s): hanyl169@gmail.com
Key Words: Intravascular ultrasound, Drug eluting stents, Scoring schemes, percutaneous coronary intervention

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Abstract: Objective: There is no simple or feasible post-procedural intravascular ultrasound (IVUS) score to predict major adverse cardiac events (MACE) in patients undergoing drug-eluting stents (DES) implantation. The aim of this study is to validate a new IVUS score for predicting MACE. Methods: A total of 295 patients (with 322 lesions) were enrolled. IVUS score was calculated in each lesion based on five IVUS morphological characteristics: inflow/outflow disease, malapposition, underexpansion, tissue protrusion, and edge dissection (iMUTE score). We assigned two points to an underexpansion and one point for each presence of other factors. Patients were divided into low score (iMUTE score<2, n=137) and high score (iMUTE score≥2, n=158) groups. Results: At one year follow-up, a trend was seen in favor of the low iMUTE score group in MACE (3.65% vs. 10.10%; P=0.052), and there was more target vessel revascularization (TVR) in the high iMUTE score group compared with low score group (6.96% vs. 1.46%; P=0.044). Low iMUTE score was an independent predictor of freedom from TVR at one year (adjusted hazard ratio (HR) 0.5, 95% confidence interval (CI) 0.1–0.8; P=0.02). Conclusions: Post-procedural IVUS iMUTE scoring was simple and feasible in clinical practice, and can provide independent prognostic value for TVR in patients undergoing DES implantation.

Reference

[1]Cheneau, E., Leborgne, L., Mintz, G.S., Kotani, J., Pichard, A.D., Satler, L.F., Canos, D., Castagna, M., Weissman, N.J., Waksman, R., 2003. Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation, 108(1):43-47.

[2]Daemen, J., Wenaweser, P., Tsuchida, K., Abrecht, L., Vaina, S., Morger, C., Kukreja, N., Juni, P., Sianos, G., Hellige, G., et al., 2007. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet, 369(9562):667-678.

[3]Fujii, K., Carlier, S.G., Mintz, G.S., Yang, Y.M., Moussa, I., Weisz, G., Dangas, G., Mehran, R., Lansky, A.J., Kreps, E.M., et al., 2005. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J. Am. Coll. Cardiol., 45(7):995-998.

[4]Gerber, R.T., Latib, A., Ielasi, A., Cosgrave, J., Qasim, A., Airoldi, F., Chieffo, A., Montorfano, M., Carlino, M., Michev, I., et al., 2009. Defining a new standard for IVUS optimized drug eluting stent implantation: the PRAVIO study. Catheter. Cardiovasc. Interv., 74(2):348-356.

[5]Hong, M.K., Mintz, G.S., Lee, C.W., Park, D.W., Choi, B.R., Park, K.H., Kim, Y.H., Cheong, S.S., Song, J.K., Kim, J.J., et al., 2006. Intravascular ultrasound predictors of angiographic restenosis after sirolimus-eluting stent implantation. Eur. Heart J., 27(11):1305-1310.

[6]Joner, M., Finn, A.V., Farb, A., Mont, E.K., Kolodgie, F.D., Ladich, E., Kutys, R., Skorija, K., Gold, H.K., Virmani, R., 2006. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J. Am. Coll. Cardiol., 48(1):193-202.

[7]Lee, C.W., Kang, S.J., Park, D.W., Lee, S.H., Kim, Y.H., Kim, J.J., Park, S.W., Mintz, G.S., Park, S.J., 2010. Intravascular ultrasound findings in patients with very late stent thrombosis after either drug-eluting or bare-metal stent implantation. J. Am. Coll. Cardiol., 55(18):1936-1942.

[8]Morice, M.C., Serruys, P.W., Sousa, J.E., Fajadet, J., Ban Hayashi, E., Perin, M., Colombo, A., Schuler, G., Barragan, P., Guagliumi, G., et al., 2002. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N. Engl. J. Med., 346(23):1773-1780.

[9]Moses, J.W., Leon, M.B., Popma, J.J., Fitzgerald, P.J., Holmes, D.R., O′Shaughnessy, C., Caputo, R.P., Kereiakes, D.J., Williams, D.O., Teirstein, P.S., et al., 2003. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N. Engl. J. Med., 349(14):1315-1323.

[10]Moses, J.W., Dangas, G., Mehran, R., Mintz, G.S., 2008. Drug-eluting stents in the real world: how intravascular ultrasound can improve clinical outcome. Am. J. Cardiol., 102(9 Suppl.):24J-28J.

[11]Pfisterer, M., Brunner-La Rocca, H.P., Buser, P.T., Rickenbacher, P., Hunziker, P., Mueller, C., Jeger, R., Bader, F., Osswald, S., et al., 2006. Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. J. Am. Coll. Cardiol., 48(12):2584-2591.

[12]Roy, P., Steinberg, D.H., Sushinsky, S.J., Okabe, T., Pinto Slottow, T.L., Kaneshige, K., Xue, Z., Satler, L.F., Kent, K.M., Suddath, W.O., et al., 2008. The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents. Eur. Heart J., 29(15):1851-1857.

[13]Schofer, J., Schluter, M., Gershlick, A.H., Wijns, W., Garcia, E., Schampaert, E., Breithardt, G., 2003. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: double-blind, randomised controlled trial (E-SIRIUS). Lancet, 362(9390):1093-1099.

[14]Sonoda, S., Morino, Y., Ako, J., Terashima, M., Hassan, A.H., Bonneau, H.N., Leon, M.B., Moses, J.W., Yock, P.G., Honda, Y., et al., 2004. Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial. J. Am. Coll. Cardiol., 43(11):1959-1963.

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