ACUTE CORONARY SYNDROMES

Impact of arterial remodelling and plaque rupture on target and non-target lesion revascularisation after stent implantation in patients with acute coronary syndrome: an intravascular ultrasound study

Hiroyuki Okura¹, Haruyuki Taguchi¹, Tomoichiro Kubo¹, Iku Toda¹, Minoru Yoshiyama², Junichi Yoshikawa³, Kiyoshi Yoshida⁴

¹ The Division of Cardiology, Bell Land General Hospital, Sakai, Japan
² The Division of Cardiology and Internal Medicine, Osaka City University Medical School, Osaka, Japan
³ The Division of Internal Medicine and Cardiology, Osaka Ekisaikai Hospital, Osaka, Japan
⁴ The Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan

Dr H Okura, Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan; hokura{at}fides.dti.ne.jp

Objectives: To investigate the impact of arterial remodelling on long-term clinical outcome after stent implantation in patients with acute coronary syndrome (ACS).

Methods: 134 patients with ACS were enrolled. External elastic membrane (EEM) cross-sectional area (CSA) and lumen CSA were measured. Plaque and media CSA was calculated as EEM minus lumen CSA. Final minimal stent area (MSA) was also measured after stenting. Positive remodelling (PR) was defined as the ratio of the EEM CSA at the target lesion to that at the proximal reference of >1.05, and intermediate or negative remodelling (IR/NR) was defined as that of 1.05.

Results: Although final MSA was similar, target lesion revascularisation (TLR) rates at 2 years were significantly higher in patients with PR (33.7%) than in those with IR/NR (13.7%; p = 0.01). In addition, non-TLR rates were also significantly higher in patients with PR (42.2%) than in those with IR/NR (23.5%; p = 0.03). Cardiac event-free survival (for events such as death, myocardial infarction, TLR and non-TLR) was significantly lower in patients with PR than in those with IR/NR (log rank, p = 0.001). By multivariate logistic regression analysis, PR (² 6.57, OR 2.70; 95% CI, 1.27 to 5.78; p = 0.01) and plaque rupture (² 4.17, OR 2.38; 95% CI, 1.04 to 5.45; p = 0.04) were independent predictors of cardiac events.

Conclusion: In patients with ACS, PR and intravascular ultrasound findings that may correspond with plaque rupture predict cardiac events including both TLR and non-TLR at 2 years.

Abbreviations: ACS, acute coronary syndrome; AMI, acute myocardial infarction; CSA, cross-sectional area; %DS, percent diameter stenosis; EEM, external elastic membrane; IR, intermediate remodelling; IVUS, intravascular ultrasound; MLD, minimal lumen diameter; MSA, minimal stent area; NR, negative remodelling; P+M, plaque plus media; PCI, percutaneous coronary intervention; PR, positive remodelling; TLR, target lesion revascularisation

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