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Predictors and implications of residual plaque burden after coronary stenting: an intravascular ultrasound study
Fernando Alfonso1, Pablo García, Gela Pimentel
1Interventional Cardiology Unit, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
Insights
Residual plaque burden after coronary stenting independently predicts restenosis. Higher plaque burden (>46%) significantly increases restenosis risk, highlighting its importance for long-term outcomes.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical imaging
Background:
- Residual atherosclerotic plaque burden after coronary stenting is visualized by intravascular ultrasound.
- Determinants and implications of residual plaque burden are not well established.
- The independent role of residual plaque burden on outcomes is unknown.
Purpose of the Study:
- To determine the predictors of residual plaque burden after stenting.
- To evaluate the implications of residual plaque burden on angiographic outcomes.
- To identify factors associated with restenosis after stenting.
Main Methods:
- Prospective study of 62 patients undergoing stenting with intravascular ultrasound guidance.
- Analysis of 616 stent slices to calculate residual plaque burden (residual plaque/vessel area x 100).
- Multiple regression and logistic regression analyses to identify predictors of residual plaque burden and restenosis.
Main Results:
- Mean residual plaque burden was 46.5% +/- 6%.
- Lesion plaque area and reference segment plaque burden predicted residual plaque burden.
- Higher residual plaque burden (>46%) correlated with adverse angiographic outcomes and increased restenosis risk (RR 4.4).
- Residual plaque burden and diabetes were independent predictors of restenosis.
Conclusions:
- Residual plaque burden after coronary stenting is an independent predictor of late angiographic outcomes.
- Managing residual plaque burden may be crucial for improving long-term results after stenting.
- Higher residual plaque burden is associated with increased risk of restenosis.
Background:
Residual plaque burden after coronary stenting may be visualized by use of intravascular ultrasound. Determinants and implications of residual atherosclerotic plaque burden after coronary stenting are not well established. In particular, the implications of residual plaque burden, after adjusting for confounding factors, are still unknown.
Methods:
Sixty-two consecutive patients (age 56 +/- 9 years) undergoing coronary stenting under intravascular ultrasound imaging guidance were prospectively studied. A total of 616 slices were analyzed (every 2 mm of stent length) from motorized pull-back recordings. Residual plaque burden was calculated as residual plaque/vessel area x 100.
Results:
In 565 slices (89%), both residual plaque area and stent area could be measured. Mean residual plaque burden was 46.5% +/- 6%. By use of multiple regression analysis, lesion plaque area and reference segment plaque burden were identified as independent predictors of residual plaque burden after stenting. In addition, a significant correlation was found between residual plaque burden and most relevant angiographic parameters at follow-up (including minimal lumen diameter, percent diameter stenosis, and loss index), which persisted after adjustment. Furthermore, stents with a residual plaque burden >or=46% had higher a restenosis rate (relative risk [RR] 4.4, 95% CI 1.09-18.2, P =.03). On logistic regression analysis, residual plaque burden (RR 4.8, 95% CI 4.1-5.6, P =.01) and diabetes (RR 4.3, 95% CI 3.6-5.1, P =.03) emerged as the only independent predictors of restenosis.
Conclusions:
The amount of residual plaque burden after coronary stenting plays an independent role on the late angiographic outcome of these patients.