918-22 Effect of Non-target Lesion Events on the Predictive Value of 6-Month Angiography for Late (12 Month) Clinical Outcome After PTCA

• Published in: Journal of the American College of Cardiology Vol. 25; no. 2; pp. 94A - 95A
• Main Authors: Chien Chuang, Ya, Popma, Jeffrey J., Foegh, Mane, Battle, William, Schaeffer, Marc, Prunka, Nina, Leon, Martin B.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.02.1995
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)91846-P

To determine whether the observed discordance between late angiographic and clinical outcomes in clinical restenosis studies (European angiopeptin: clinical but not angiographic benefit; CAVEAT: angiographic but not clinical benefit) is affected by the occurrence of late non-target lesion events (death, myocardial infarction [MI], or remote-site revascularization), we reviewed the outcomes of 1061 successfully-treated patients (<50% stenosis and no death, MI, CABG or repeat PTCA<14 days) enrolled in the American Angiopeptin restenosis study, a randomized restenosis trial of placebo vs bolus subcutaneous angiopeptin (no effect). During the 12-month follow-up period, major cardiac events (death [1.2%], Ml [2.7%], or any revascularization [31.9%]) occurred in 34.4% of patients. Target-lesion revascularization (TLRI (PTCA or CABG based on clinical sites assessment of symptom status and angiography) was required in 25.4% patients; non-TLR (remote sitesl was performed in 12.3%. Angiographic follow-up (FUI was obtained≤6 months after PTCA and quantitative analysis (ImageComm) was performed. A Receiver Operating Characteristic (ROC) curve was constructed to determine the predictive value of the FU % stenosis for TLR and any late cardiac event (Figure). The predictive value of FU % stenosis was higher for TLR (≤50%: sensitivity, 87%; specificity, 78%) than for any cardiac event(≥50% stenosis: sensitivity, 72%; specificity, 79%). attributable to the occurrence of non-TLR events. We conclude that: 11 clinical and angiographic outcomes are correlated when TLR is used as an endpoint for clinical restenosis; and 21 nontarget lesion events may contribute to the observed discordance between angiographic and clinical outcomes within the 12 months following PTCA.