701-4 Factors Associated with Late Angiographic Outcome After Intravascular Ultrasound Guided Palmaz-Schatz Coronary Stent Implantation: A Multivariate Analysis

Abstract

Intravascular ultrasound (IVUS) has been used to guide stent implantation procedures and to optimize stent expansion. The long term effect that the improved stent expansion achieved with IVUS guidance has on restenosis has not been evaluated. Successful IVUS guided Palmaz Schatz coronary stent implantation was performed in 429 consecutive lesions (ies) in 359 patients (pts). In this cohort, based on IVUS evaluation, 70% of the stents required further stent dilation despite an angiographic good result. Angiographic follow up was obtained in 310 lesions (72%). Restenosis (by 50% diameter stenosis criteria) occurred in 64 lesions (21%). To determine the angiographic, clinical and procedural factors associated with restenosis, univariate analysis (UN) and stepwise logistical regression (MR) was performed on the 310 lesions with angiographic follow up. The results between the restenosis (Yes) and no restenosis (No) groups are summarized in the table below: Factors Restenosis UN MR No Yes Lesions 256 64 Age 58 ± g 62 ± 9 0.041 0.0001 Reference Vessel (mm) 3.35 ± 052 3.00 ± 0.52 0.0001 0.0001 Baseline MLD (mm) 0.97 ± 0.53 0.79 ± 044 0.019 ns Final Stent MLD (mm) 3.46 ± 055 3.09 ± 0.52 0.0001 ns Final % DS -8 ± 14 -5 ± 18 0.20 ns Lesion Length (mm) 8.8 ± 5.8 13 ± 7.8 0.0001 0.0001 Stent Number 1.4 ± 0.8 1.8 ± 13 0.0026 ns MLD; Minimim lumen diameter, DS: Diameter stenosis. (1) In this cohort that had stent expansion optimized by IVUS guidance, advanced age, small vessels and long lesion length were the strongest independent predictors of restenosis. (2) These results confirm previously reported analysis of angiographic data that small vessel diameter is a strong predictor of restenosis. (3) Long lesion length rather than number of stents is a stronger independent predictor of restenosis.