Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation: An ADAPT-DES Intravascular Ultrasound Substudy

• Published in: Circulation. Cardiovascular interventions Vol. 9; no. 7; p. e003553
• Main Authors: Kobayashi, Nobuaki, Mintz, Gary S, Witzenbichler, Bernhard, Metzger, D Christopher, Rinaldi, Michael J, Duffy, Peter L, Weisz, Giora, Stuckey, Thomas D, Brodie, Bruce R, Parvataneni, Rupa, Kirtane, Ajay J, Stone, Gregg W, Maehara, Akiko
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.07.2016
• Subjects: Aged; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - epidemiology; Chi-Square Distribution; Coronary Aneurysm - diagnostic imaging; Coronary Aneurysm - epidemiology; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary Vessels - diagnostic imaging; Cross-Sectional Studies; Drug-Eluting Stents; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Predictive Value of Tests; Prevalence; Prospective Studies; Prosthesis Design; Risk Factors; Time Factors; Treatment Outcome; Ultrasonography, Interventional; stent; prevalence; drug-eluting stent; angiography; dissection
• ISSN: 1941-7640; 1941-7632
• DOI: 10.1161/CIRCINTERVENTIONS.115.003553

BACKGROUND—Intravascular ultrasound detects stent edge dissections after percutaneous coronary intervention that are not seen angiographically. This study investigated the association between stent edge dissections and clinical outcomes. METHODS AND RESULTS—ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a large-scale, prospective, multicenter study of patients undergoing drug-eluting stent implantation. In this prospective substudy, 2062 patients (2433 lesions) were evaluated with intravascular ultrasound to characterize the morphological features and clinical outcomes of stent edge dissection after percutaneous coronary intervention. The prevalence of post–percutaneous coronary intervention stent edge dissection was 6.6% per lesion (161 of 2433). Calcified plaque at the proximal stent edge (relative risk [RR]=1.72; P=0.04) and proximal stent edge expansion (RR=1.18; P=0.004) were predictors for proximal dissection; attenuated plaque at the distal stent edge (RR=3.52; P=0.004), distal reference plaque burden (RR=1.56; P<0.0001), and distal edge stent expansion (RR=1.11; P=0.02) were predictors for distal dissection. At 1-year follow-up, target lesion revascularization was more common in lesions with versus without dissection (5.2% versus 2.7%; P=0.04). Multivariable analysis indicated that residual dissection was associated with target lesion revascularization at 1-year follow-up (RR=2.67; P=0.02). Among lesions with dissection, smaller effective lumen area increased the risk of target lesion revascularization at 1-year follow-up (cutoff value of 5.1 mm; P=0.05). CONCLUSIONS—Greater stent expansion and the presence of large, calcified, and/or attenuated plaques were independent predictors of stent edge dissection. Residual stent edge dissection, especially with a smaller effective lumen area, was associated with target lesion revascularization during 1-year follow-up after drug-eluting stent implantation. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT00638794.