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Serial Change and Clinical Impact of Irregular Protrusion in Lesions With Chronic Coronary Syndrome
Naotaka Okamoto1, Isamu Mizote2, Takayuki Ishihara3
1Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan.
Insights
Irregular protrusion (IP) in chronic coronary syndrome (CCS) lesions decreases over time but predicts long-term adverse outcomes. Residual IP at 1 month significantly increases the risk of target lesion revascularization (TLR).
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Irregular protrusion (IP) is a post-stent finding in chronic coronary syndrome (CCS) with unclear long-term clinical implications.
- The evolution of IP over time and its impact on outcomes beyond one year remain largely unknown.
Purpose of the Study:
- To evaluate the time-dependent changes in IP after stent implantation in CCS patients.
- To assess the long-term clinical impact of IP on target lesion revascularization (TLR) over a 3-year period.
Main Methods:
- Post hoc analysis of the prospective, multicenter COLLABORATION study.
- Serial optical coherence tomography (OCT) and coronary angioscopy were used to assess IP at baseline, 1 month, and 12 months.
- Comparison of 3-year cumulative TLR incidence between lesions with and without IP, and residual IP at 1 month.
Main Results:
- IP was detected in 35.5% of lesions post-stent.
- IP resolved significantly over time, with 23.7% remaining at 1 month and 5.3% at 12 months.
- Lesions with IP had a higher 3-year TLR rate (13.6% vs. 3.0%, p=0.04). Residual IP at 1 month showed a markedly higher TLR rate (33.3% vs. 4.3%, p<0.01).
Conclusions:
- While IP presence diminishes over time, a significant proportion persists at 1 month.
- Both the initial presence of IP and residual IP at 1 month are critical OCT findings predicting higher rates of long-term TLR in CCS patients.
Background:
The changes over time and effects on long-term clinical outcomes beyond 1 year of irregular protrusion (IP) in chronic coronary syndrome (CCS) remains unclear.
Aims:
This study aimed to assess the time-dependent change and long-term clinical impact of IP in CCS lesions.
Methods:
This study was a post hoc analysis of COLLABORATION study, which was a multicenter, prospective, observational study conducted from July 2018 to February 2020, assessing 1- and 12-month serial vessel responses after stent implantation using OCT and coronary angioscopy. Time-dependent change in the presence of IP was evaluated using the serial OCT examinations. The cumulative 3-year incidence of TLR was compared between the lesions with and without IP, as well as between those with and without residual IP at 1 month.
Results:
Among 107 lesions, IP was detected in post-OCT pullbacks in 38 (35.5%) lesions. Out of the 38 lesions, IP remained in 9 (23.7%) lesions at 1 month and existed in 2 (5.3%) lesions at 12 months. The cumulative 3-year incidence of TLR was significantly higher in IP group than in non-IP group (13.6% vs. 3.0%, p = 0.04). Similarly, it was significantly higher in lesions with residual IP at 1 month than those without (33.3% vs. 4.3%, p < 0.01). All residual IP at 1 month were composed of angioscopic yellow plaques and red thrombi.
Conclusions:
The presence of IP decreased over time, but approximately one-fourth of IP remained at 1 month. IP and residual IP at 1 month were important post-stent OCT findings leading to long-term TLR in patients with CCS.
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