782-4 Influence of Epicardial Lesion Location on Late Luminal Renarrowing and Angiographic Outcome After Successful Balloon Angioplasty, Directional Atherectomy, Stent Implantation and Excimer Laser Angioplasty

Abstract

Left anterior descending (LAD) coronary artery location is reported to be associated with increased propensity to restenosis after intervention. This study, in 3736 patients, investigates whether this finding is equally applicable to intervention with balloon angioplasty (BA, n = 3797 lesions), directional atherectomy (DCA, n = 200 lesions), Palmaz-Schatz stent implantation (PS, n = 229 lesions) and excimer laser angioplasty (ELCA, n = 116 lesions). Automated core laboratory quantitative analysis (OCA) was performed in multiple matched angiographic projections pre and post intervention and at 6 month follow up (overall QCA follow up 93%). Multiple linear regression analysis was employed to determine whether LAD lesion location was associated with greater propensity to luminal renarrowing, independently of lesion severity pre, procedural luminal increase and reference vessel diameter. Because of the large variation in vessel size, lumen renarrowing was measured as relative luminal loss (minimal luminal diameter (MLD) post-follow up/reference diameter pre) and angiographic outcome as relative lumen at follow up (MLD at follow up/reference diameter pre). In multivariate analysis applied to the entire patient population, LAD location was independently associated with greater relative loss and smaller lumen at follow up (p = 0.007). However, application of the model to each patient group separately, revealed analogous findings for the DCA (p = 0.003) and BA (p = 0.03) groups, but no significant association between LAD location and late angiographic results was evident in the PS (p = 0.18) or ELCA (p = 0.55) groups. Retrospective exclusion of totally occluded lesions at baseline and/or at follow up from the analysis did not appreciable alter these findings. LAD lesions were independently associated with less favourable late angiographic results after balloon angioplasty or directional atherectomy, whereas late results after Palmaz-Schatz stent implantation or excimer laser angioplasty did not vary with lesion location. In contrast with previous reports, these findings suggest a differential influence of lesion location on late interventional results, depending on the device used. Accordinglyfurther investigation will be required for clarification of this association.