Impact of Arterial Remodeling and Plaque Rupture on Target and Non-Target Lesion Revascularization Following Stent Implantation in Patients with Acute Coronary Syndrome: An Intravascular Ultrasound Study

Hiroyuki Okura ^1*, Haruyuki Taguchi ¹, Tomoichiro Kubo ¹, Iku Toda ¹, Minoru Yoshiyama ², Junichi Yoshikawa ³ and Kiyoshi Yoshida ⁴

¹ Bell Land General Hospital, Japan
² Osaka City University Medical School, Japan
³ Osaka Ekisaikai Hospital, Japan
⁴ Kawasaki Medical School, Japan

^* To whom correspondence should be addressed. E-mail: hokura{at}fides.dti.ne.jp.

Accepted 30 January 2007

Abstract

Objectives The aim of this study was to investigate impact of arterial remodeling on long-term clinical outcome following stent implantation in patients with acute coronary syndrome (ACS).

Methods A total of 134 patients with ACS were enrolled. External elastic membrane cross sectional area (EEM CSA) and lumen CSA were measured. Plaque plus media (P+M) CSA was calculated as EEM minus lumen CSA. Final minimal stent area (MSA) was also measured after stenting. Positive remodeling (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 remodeling (IR/NR) was defined as that of 1.05.

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

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

Keywords: acute coronary syndrome, prognosis, remodeling, stent, ultrasound

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