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Published on: August 28, 2018
Angiographic Predictors for Repeated Revascularization in Patients with Intermediate Coronary Lesions
Yong-Kyun Kim1, Soon-Ho Kwon1, Young-Hoon Seo1
1Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon 35365, Republic of Korea.
Insights
Angiographic haziness and diameter stenosis over 60% predict the need for target lesion revascularization in intermediate coronary lesions. These findings aid in guiding treatment decisions for complex intermediate lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Intermediate lesions (ILs) pose challenges in therapeutic decision-making.
- Accurate prediction of revascularization needs is crucial for optimal patient management.
Purpose of the Study:
- To identify practical coronary angiographic predictors for target lesion revascularization (TLR) in patients with ILs.
- To evaluate the association between specific angiographic features and the need for revascularization.
Main Methods:
- Retrospective single-center study of patients with ILs undergoing repeated angiograms.
- Comparison of angiographic characteristics between patients who did and did not undergo TLR.
- Analysis of lesion features including branches, irregularity, tortuosity, ulcer/erosion, haziness, and calcification.
Main Results:
- Higher percentage of diameter stenosis (% DS) and presence of haziness were observed in the TLR group.
- Angiographic haziness (HR=2.126) and % DS ≥ 60% (HR=1.025) were independent predictors of TLR.
- Lesion length did not show significant differences between groups.
Conclusions:
- Angiographic haziness and % DS > 60% are independent predictors for TLR in patients with ILs.
- These findings represent the first angiographic identification of vulnerable plaques in ILs.
- Intravascular imaging or physiologic studies are recommended for ILs with these features before treatment decisions.
Abstract:
Background: Intermediate lesions (ILs) present challenges in making therapeutic decisions. This study aimed to determine the practical coronary angiographic predictors for revascularization in patients with ILs who underwent repeated angiograms. Methods: This study was a retrospective single-center study. The study subjects were divided into two groups according to their target lesion revascularization (TLR) during the follow-up period: the TLR (+) group (n = 135, 30.9%) and the TLR (-) group (n = 302, 69.1%). We evaluated the angiographic characteristics of ILs such as the presence of branches, luminal irregularity, tortuosity, ulcer/erosion, haziness, and calcification in the ILs, with an average follow-up of 34.2 ± 32.0 months. Results: The TLR (+) group had higher percentage of diameter stenoses (47.3 ± 13.5% vs. 44.2 ± 12.2%, p = 0.006) than the TLR (-) group, whereas the lesion length of the ILs showed no significant differences between the two groups. The prevalence of branches (79.0% vs. 69.1%, p = 0.018) and haziness (4.3% vs. 2.6%, p < 0.001) was higher in the ILs of the TLR (+) group than those of the TLR (-) group. Therefore, the angiographic predictors for the TLR of ILs were haziness (hazard ratio = 2.126, 95% confidence interval = 1.240-3.644, p = 0.006) and % diameter stenosis (DS) ≥ 60% (hazard ratio = 1.025, 95% confidence interval = 1.013-1.037, p < 0.001). Conclusions: Angiographic haziness and % DS > 60% were the independent angiographic predictors for TLR in patients with ILs. Our study is the first to present the angiographic findings of vulnerable plaques of ILs. Further studies such as intravascular imaging or physiologic studies should be strongly considered before making treatment decisions in ILs when such angiographic features are observed.
