Impact of Arterial Remodeling of Intermediate Coronary Lesions on Long-Term Clinical Outcomes in Patients with Stable Coronary Artery Disease: An Intravascular Ultrasound Study.

Liang Geng,Qi Zhang,Peizhao Du,Liming Gao,Yuan Yuan,Yunkai Wang,Jiming Li,Faisal Latif

doi:10.1155/2021/9915759

Abstract

Background Treatment of coronary intermediate lesions remains a controversy, and the role of arterial remodeling patterns determined by intravascular ultrasound in intermediate lesion is still not well known. The aim of this study was to investigate the impact of arterial remodeling of intermediate coronary lesions on long-term clinical outcomes. Methods Arterial remodeling patterns were assessed in 212 deferred intermediate lesions from 162 patients after IVUS examination. Negative, intermediate, and positive remodeling was defined as a remodeling index of <0.88, 0.88∼1.0, and >1.0, respectively. The primary endpoint was the composite vessel-oriented clinical events, defined as the composition of target vessel-related cardiac death, target vessel-related myocardial infarction, and target vessel revascularization. Quantitative flow ratio was assessed for evaluating the functional significance of intermediate lesions. Results 72 intermediate remodeling lesions were present in 66 patients, whereas 77 negative remodeling lesions were present in 71 patients, and 63 positive remodeling lesions were present in 55 patients. Negative remodeling lesions had the smallest minimum lumen area (4.16 ± 1.03 mm2 vs. 5.05 ± 1.39 mm2 vs. 4.85 ± 1.76 mm2; P < 0.01), smallest plaque burden (63.45 ± 6.13% vs. 66.12 ± 6.82% vs. 71.17 ± 6.45%; P < 0.01), and highest area stenosis rate (59.32% ± 10.15% vs. 54.61% ± 9.09% vs. 51.67% ± 12.96%; P < 0.01). No significant difference was found in terms of quantitative flow ratio among three groups. At 5 years follow-up, negative remodeling lesions had a higher rate of composite vessel-oriented clinical event (14.3%), compared to intermediate (1.4%, P=0.004) or positive remodeling lesions (4.8%, P=0.06). After adjusting for multiple covariates, negative remodeling remained an independent determinant for vessel-oriented clinical event (HR: 4.849, 95% CI 1.542–15.251, P=0.007). Conclusion IVUS-derived negative remodeling is associated with adverse long-term clinical outcome in stable patients with intermediate coronary artery stenosis.

Highlights

Risk stratification and management strategy of intermediate coronary lesions, defined as 50–70% diameter stenosis (DS) at coronary angiography [1, 2], remain a challenging issue [3, 4]
Percutaneous coronary intervention (PCI) with drug-eluting stent implantation for every intermediate lesion could increase the risk of stent thrombosis or restenosis, whereas deferral revascularization of high-risk intermediate lesions might be associated with a higher risk of long-term events [5, 6]
Male gender was higher in proportion, and serum levels of creatinine and HbA1C were more elevated in patients with positive arterial remodeling, but the three remodeling patterns did not differ significantly with respect to other traditional risk factors, clinical presentations, and medications at discharge (Table 1)

Summary

Introduction

Risk stratification and management strategy of intermediate coronary lesions, defined as 50–70% diameter stenosis (DS) at coronary angiography [1, 2], remain a challenging issue [3, 4]. Previous studies have shown that arterial remodeling assessed by IVUS in vivo affects hemodynamic stress on the lesion site [8,9,10] and is correlated with clinical Journal of Interventional Cardiology presentation [11, 12]. 162 patients with 212 de novo intermediate coronary lesions were included in the final analysis and divided into three groups according to the remodeling index (Figure 1).

Results

Conclusion