Target Lesion Revascularization After Intravascular Ultrasound-Guided Percutaneous Coronary Intervention

Area of Science:

• Cardiovascular Interventions
• Medical Imaging
• Interventional Cardiology

Background:

• Optimal stent expansion criteria using intravascular ultrasound (IVUS) for predicting clinical outcomes after percutaneous coronary intervention (PCI) are controversial.
• Limited research exists on the combined utility of stent expansion criteria and clinical/procedural factors in predicting target lesion revascularization (TLR) post-IVUS-guided PCI.

Purpose of the Study:

• To evaluate the predictive value of various IVUS-derived stent expansion criteria, alongside clinical and procedural factors, for 1-year target lesion revascularization (TLR) after complex multivessel PCI.

Main Methods:

• Prospective multicenter OPTIVUS-Complex PCI study enrolled 961 patients undergoing multivessel PCI with IVUS guidance.
• Compared multiple stent expansion criteria (e.g., minimum stent area [MSA], OPTIVUS, IVUS-XPL, ULTIMATE, MUSIC) and clinical/procedural factors for association with TLR.
• Analyzed 1957 lesions for 1-year TLR incidence and identified independent risk factors.

Main Results:

• The 1-year cumulative incidence of lesion-based TLR was low at 1.6% (30 lesions).
• Univariate associations with TLR included hemodialysis, proximal left anterior descending artery lesions, calcified lesions, small proximal reference lumen area, and small MSA.
• Independent predictors of TLR were calcified lesions (HR 2.34) and small proximal reference lumen area (Tertile 1 HR 7.01; Tertile 2 HR 5.40).

Conclusions:

• Contemporary IVUS-guided PCI practice is associated with a very low 1-year TLR rate.
• Minimum stent area (MSA) showed a univariate association with TLR, but other stent expansion criteria did not.
• Calcified lesions and small proximal reference lumen area were identified as independent risk factors for TLR.