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Impact of post‐procedural minimal stent area on 2‐year clinical outcomes in the SYNTAX II trial
Author(s) -
Katagiri Yuki,
De Maria Giovanni Luigi,
Kogame Norihiro,
Chichareon Ply,
Takahashi Kuniaki,
Chang Chun Chin,
Modolo Rodrigo,
Walsh Simon,
Sabate Manel,
Davies Justin,
Lesiak Maciej,
Moreno Raul,
CruzGonzalez Ignacio,
West Nick E.J.,
Piek Jan J.,
Wykrzykowska Joanna J.,
Farooq Vasim,
Escaned Javier,
Banning Adrian P.,
Onuma Yoshinobu,
Serruys Patrick W.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28105
Subject(s) - medicine , conventional pci , lesion , intravascular ultrasound , myocardial infarction , revascularization , stent , target lesion , cardiology , stroke (engine) , clinical trial , radiology , percutaneous coronary intervention , surgery , mechanical engineering , engineering
Objectives To investigate the impact of minimal stent area (MSA) evaluated by post‐procedural intravascular ultrasound (IVUS) on clinical outcomes after contemporary PCI in patients with three‐vessel disease (TVD). Background The impact of post‐procedural MSA on clinical outcomes has not yet been extensively studied in patients with TVD. Methods The SYNTAX II study is a multicenter, all‐comers, open‐label, single arm study that investigated the impact of a state‐of‐the‐art PCI strategy on clinical outcomes in patients with TVD (454 patients with 1,559 lesions). The relationships between post‐procedural MSA and lesion‐level outcomes at 2 years were investigated. Clinical events adjudicated per patient by clinical event committee were assessed per lesion. Lesion‐oriented composite endpoint (LOCE) was defined as the composite of cardiac death, target‐vessel myocardial infarction, and ischemia‐driven target lesion revascularization. Results Eight hundred and nineteen lesions with post‐procedural MSA available in 367 patients were included in the analysis. The post‐procedural MSA per lesion was divided into terciles (smallest tercile: ≤5.0 mm 2 , intermediate tercile: 5.0–6.7 mm 2 , and largest tercile: >6.7 mm 2 ). LOCE was observed in 16/288 (5.6%), 15/265 (5.7%), and 8/266 (3.0%) ( P = 0.266). Target lesion revascularization (TLR) was observed in 16/288(5.6%), 12/265 (4.5%), and 4/266 (1.5%) ( P = 0.042). The multivariate analysis demonstrated that smaller post‐procedural MSA, as well as creatinine clearance, history of previous stroke, chronic total occlusion, and lesion SYNTAX Score was an independent predictor of TLR. Conclusions In the SYNTAX II trial, larger post‐procedural MSA was independently associated with the lower rate of TLR at 2 years.