Abstract 13724: Intravascular Ultrasound and Angiographic Predictors for 5-Year Target Lesion Revascularization After Second Generation Drug-Eluting Stent Implantation

Abstract

Background: Late target lesion revascularization (TLR) remains an unresolved problem in drug-eluting stents (DES). This study aimed to evaluate whether angiography and IVUS at mid-term can predict late-TLR in lesions treated with 2nd generation DES. Methods: Clinical outcomes were followed for 5 years in 1265 lesions with no TLR within the 1st year after Endeavor zotarolimus- (E-ZES, n=748), Resolute zotarolimus- (R-ZES, n=195), and everolimus-eluting stent (EES, n=322) implantation. Quantitative coronary angiography (QCA) and IVUS were performed at baseline and mid-term (8-12 months) follow-up. Results: During 1 to 5 years, R-ZES and EES showed equivalent late-TLR rates, while E-ZES demonstrated significantly less late-TLR than other stents (4.6%, 4.3% and 1.5%, respectively. Log Rank p=0.002). In E-ZES, no QCA or IVUS variables predicted late-TLR. In contrast, the late-TLR group in R-ZES and EES had smaller minimum lumen diameter (MLD), greater neointima and more late-acquired incomplete stent apposition (LISA) at mid-term follow-up, as well as greater increases of vessel and peri-stent plaque volumes during the follow-up. Multiple logistic regression analysis determined follow-up MLD, LISA and the increase of peri-stent plaque at mid-term as independent predictors of late-TLR in R-ZES and EES. In particular, with ROC-determined cutoff values, lesions with ≥2 predictors had a relative risk of 14.4 for late-TLR. Conclusion: The incidence and determinants of late-TLR can vary depending on the drug, carrier and release kinetics. Despite a trend for more TLR within the 1st year, E-ZES with phosphorylcholine coating was associated with an extremely low incidence of late-TLR and stable vessel response surrounding the stent. R-ZES and EES with durable polymer and longer release kinetics showed similar rates of late-TLR, possibly related to pathological responses of the stented artery that may be detectable by IVUS within the 1st year after implantation.