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Multivariate predictors of intravascular ultrasound end points after directional coronary atherectomy
F A Matar1, G S Mintz, E Pinnow
1Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, Washington, D.C.
Insights
The preintervention lesion arc of calcium, identified by intravascular ultrasound, consistently predicts directional coronary atherectomy outcomes. This finding aids in optimizing procedural success and patient results.
Area of Science:
- Cardiovascular Interventions
- Medical Imaging
- Interventional Cardiology
Background:
- Directional coronary atherectomy (DCA) outcomes are influenced by various factors.
- Previous studies linked angiographic and intravascular ultrasound (IVUS) variables to DCA success.
- No prior research integrated both IVUS and angiography into a unified predictive model for DCA.
Purpose of the Study:
- To identify clinical, angiographic, procedural, and IVUS predictors of DCA results.
- To establish a predictive model for DCA outcomes using multi-modality data.
Main Methods:
- 170 patients underwent pre- and post-intervention IVUS and quantitative angiography.
- Clinical and procedural data were collected via chart review.
- Multivariate linear regression analyzed predictors of post-atherectomy lumen area, narrowing, and plaque removal.
Main Results:
- Pre-intervention calcium arc and plaque burden predicted residual lumen area.
- Calcium arc, plaque burden, and lesion length predicted residual narrowing.
- Calcium arc and atherectomy device size predicted plaque volume removal.
Conclusions:
- The pre-intervention lesion calcium arc, assessed by IVUS, is the most reliable predictor of DCA effectiveness.
- IVUS-derived calcium arc measurement is crucial for predicting procedural outcomes.
Objectives:
This study attempted to identify the clinical, angiographic, procedural and intravascular ultrasound predictors of directional atherectomy results assessed by intravascular ultrasound.
Background:
Several angiographic and intravascular ultrasound variables have been associated with the outcome of directional coronary atherectomy. No study has incorporated both modalities into a predictive model.
Methods:
One hundred seventy patients were analyzed using preintervention and postintervention intravascular ultrasound and quantitative angiography. Clinical and procedural variables were collected by independent chart review. Quantitative and qualitative angiographic analysis was performed by a core laboratory in blinded manner. Intravascular ultrasound was performed using a transducer-tipped catheter, rotating within a stationary imaging sheath, and withdrawn automatically at 0.5 mm/s. Clinical, procedural, angiographic and ultrasound variables were tested in a multivariate linear regression model. Dependent ultrasound variables included postatherectomy lumen cross-sectional area and percent cross-sectional narrowing (plaque plus media/external elastic membrane cross-sectional area) and, in a subgroup of 47 patients studied using volumetric analysis, percent plaque volume removal.
Results:
By multivariate stepwise linear regression analysis, predictors of residual lumen cross-sectional area (correcting for reference lumen area) included arc of calcium and preatherectomy plaque plus media cross-sectional area; predictors of residual cross-sectional narrowing were arc of calcium, preatherectomy plaque plus media cross-sectional area and lesion length; and predictors of percent plaque volume removal were arc of calcium and atherectomy device size.
Conclusions:
The preintervention lesion arc of calcium measured by intravascular ultrasound is the most consistent predictor of the effectiveness and results of directional coronary atherectomy.