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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
  1. Hiroyuki Okura1,
  2. Haruyuki Taguchi1,
  3. Tomoichiro Kubo1,
  4. Iku Toda1,
  5. Minoru Yoshiyama2,
  6. Junichi Yoshikawa3,
  7. Kiyoshi Yoshida4
  1. 1
    The Division of Cardiology, Bell Land General Hospital, Sakai, Japan
  2. 2
    The Division of Cardiology and Internal Medicine, Osaka City University Medical School, Osaka, Japan
  3. 3
    The Division of Internal Medicine and Cardiology, Osaka Ekisaikai Hospital, Osaka, Japan
  4. 4
    The Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
  1. Dr H Okura, Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan; hokura{at}fides.dti.ne.jp

Abstract

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 (χ2 6.57, OR 2.70; 95% CI, 1.27 to 5.78; p = 0.01) and plaque rupture (χ2 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.

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Footnotes

  • Competing interests: None declared.

  • 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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