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Angiographic late lumen loss revisited: impact on long-term target lesion revascularization

Taku Asano1,2, Patrick W Serruys3, Carlos Collet1,4

  • 1Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.

European Heart Journal
|August 21, 2018
PubMed

Insights

Late lumen loss (LLL) values in coronary device trials are very low. A late lumen loss greater than 0.50 mm significantly predicts target lesion revascularization, but lower values do not. This suggests LLL may not be a useful metric for comparing modern devices.

Area of Science:

  • Cardiovascular research
  • Interventional cardiology
  • Medical device technology

Background:

  • Angiographic late lumen loss (LLL) values in contemporary coronary device trials are exceptionally low.
  • The relationship between LLL and clinical outcomes, such as target lesion revascularization (TLR), requires recent re-evaluation.
  • Assessing the predictive value of LLL for TLR is crucial for understanding device performance.

Purpose of the Study:

  • To investigate the impact of late lumen loss (LLL) on target lesion revascularization (TLR).
  • To analyze the relationship between LLL and TLR using both patient-level and study-level data from contemporary coronary devices.
  • To re-evaluate the clinical significance of LLL in the era of advanced drug-eluting stents (DES).

Main Methods:

  • A patient-level meta-analysis of seven randomized controlled trials (2426 patients) using first- and second-generation drug-eluting stents (DES).
  • A study-level meta-analysis of 40 studies (19,199 patients) involving CE-marked DES.
  • Statistical analyses included probability regression, Cox proportional hazard models, and meta-regression to assess the association between LLL and TLR incidence.

Main Results:

  • A patient-level analysis revealed an exponential relationship between in-stent LLL and the 2-year incidence of TLR.
  • The optimal cut-off for predicting 2-year TLR was an LLL >0.50 mm.
  • LLL >0.50 mm was independently associated with increased TLR up to 4 years (adjusted HR 6.62).
  • Pooled mean LLL in DES studies was 0.23 mm, with moderate correlation between LLL >0.50 mm and TLR incidence at 1 and 5 years.

Conclusions:

  • An angiographic late lumen loss (LLL) threshold of 0.50 mm is critical for predicting target lesion revascularization (TLR).
  • LLL values below 0.50 mm are not predictive of TLR incidence.
  • Low LLL in current device trials may limit its utility as a discriminating parameter for comparative device evaluation.
Abstract

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