701-1 Relationship of Coronary Lesion Length to Late Angiographic and Clinical Outcome After Successful Balloon Angioplasty

Abstract

The influence of target lesion length, measured by an automated edge detection system (CAAS), on late angiographic and clinical outcome after successful coronary balloon angioplasty (SA), was investigated among 3124 patients with 3513 non-occlusive native coronary lesions. Quantitative angiography was performed before and after BA and at 6 month follow up. Visually assessed post-BA diameter stenosis <50% was considered successful. Late clinical outcome was considered as occurrence of or freedom from, major adverse cardiac events (“MACE”: death, myocardial infarction, coronary artery bypass graft surgery, re-intervention), or target lesion reocclusion at follow up angiography, within 6 months of BA. In univariate analysis, longer lesions were associated with larger reference vessel diameter (p < 0.0001) and greater acute luminal gain (p < 0.01), but also greater late loss (p < 0.001) and greater % stenosis at follow up (p < 0.0001). To determine whether lesion length is an independent determinant of late loss or late luminal diameter, multiple linear regression analysis was carried out, including the influence of lesion location, vessel size, pre-procedural minimal luminal diameter and procedural luminal gain. Although lesion length was associated with larger vessel size, which is an independent determinant of less luminal loss (p < 0.0001), longer lesions were found to be independently associated with greater late loss and a smaller luminal diameter at follow up. Dividing the lesion population in 9 equal groups (noniles), the shortest lesions (mean 2.98 ± 0.66 mm) had a loss of 0.25 ± 0.49 mm and a % stenosis at follow up of 43 ± 20% while the longest (mean 10.86 ± 1.70 mm) had a loss of 0.37 ± 0.55 mm and a % stenosis at follow up of 50 ± 19% (p < 0.0001). Despite these angiographic findings of poorer late angiographic results, the frequency of major adverse cardiac events, total occlusion or binary restenosis (diameter stenosis ≥ 50%) at follow up, did not vary with lesion length. Although longer coronary lesions are independently associated with less favourable late angiographic results after successful balloon angioplasty, this does not appear to translate into poorer late clinical outcome. The long term clinical implications of angiographically quantified preinterventionallesion length remain to be determined.