Outcomes of stent optimisation in intravascular ultrasound-guided interventions for long lesions or chronic total occlusions.

Abstract

We sought to investigate the incidence, predictors, and clinical outcomes of stent optimisation with intravascular ultrasound (IVUS) in long coronary lesions treated with new-generation drug-eluting stents (DESs). From four randomised trials comparing IVUS and angiography guidance in long (≥26 mm) or chronic total occlusion coronary lesions, a total of 1,396 patients who underwent IVUS-guided intervention were classified into two groups (stent optimisation and non-optimisation) according to optimisation criteria (minimal stent area [MSA] ≥5.5 mm2 or 80% of mean reference lumen area [MLA]). Major adverse cardiac event (MACE) occurrence, defined as a composite of cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularisation, was compared. Stent optimisation was not met in 578 (41%) patients. Predictors of non-optimisation were older age, longer lesion length, and smaller stent diameter. The MACE rate was significantly higher in the non-optimisation versus the stent optimisation group (4.8% vs 1.9%, log-rank p=0.002; adjusted hazard ratio 2.95, 95% CI: 1.43-6.06). Among possible combinations of absolute and relative expansion criteria, the one best predicting MACE was at least one of MSA ≥5.4 mm2 and/or ≥80% of MLA (Youden index=0.264). Achieving stent optimisation using IVUS evaluation was associated with favourable outcomes in IVUS-guided, new-generation DES implantation for long coronary lesions including CTOs.