Usefulness of residual percent plaque area after percutaneous coronary intervention in predicting peristent positive...

The aim of this study was to determine whether a stented coronary artery might be positively remodeled, which factors predict this phenomenon, and whether positive remodeling has an association with late outcome. The study population consisted of 230 lesions in 230 patients who received bare-metal stents. We performed intravascular ultrasound analyses before and after the procedure and at follow-up. An artery was defined as positively remodeled if the ratio of follow-up to postvessel area was > or =1.1. The following indexes were calculated and defined: (1) late loss = postluminal area - follow-up luminal area; (2) percent plaque area = ([vessel area - luminal area]/vessel area x 100), (3) Delta% plaque area = follow-up percent plaque area - postprocedure percent plaque area. Although late loss in the positively remodeled group was significantly smaller than that in the nonremodeled group (p<0.05), d% plaque area in the former group was significantly larger than that in the latter group (p<0.05). The rate of restenosis in the positive remodeling group (16.4%) was significantly lower than that in the nonremodeling group (28.2%) (p<0.05). In multivariate analysis, postprocedure percent plaque area was the only powerful independent predictor for peristent positive remodeling and was inversely associated with this phenomenon in both groups (odds ratio 0.944, 95% confidence interval 0.914 to 0.975, p=0.0004). This study indicates that postprocedure percent plaque area could predict the occurrence of peristent positive remodeling at follow-up and that this phenomenon might influence late outcome.