Journal article
Angiographic late lumen loss revisited: impact on long-term target lesion revascularization.
- Asano T Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.
- Serruys PW NHLI, Imperial College London, Dovehouse Street, Chelsea, London, UK.
- Collet C Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.
- Miyazaki Y ThoraxCenter, Erasmus Medical Center, Doctor Molewaterplein 40, GD Rotterdam, The Netherlands.
- Takahashi K Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.
- Chichareon P Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.
- Katagiri Y Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.
- Modolo R Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.
- Tenekecioglu E ThoraxCenter, Erasmus Medical Center, Doctor Molewaterplein 40, GD Rotterdam, The Netherlands.
- Morel MA Cardialysis, Westblaak 98, KM Rotterdam, The Netherlands.
- Garg S East Lancashire Hospitals NHS Trust, Casterton Ave, Burnley, UK.
- Wykrzykowska J Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.
- Piek JJ Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands.
- Sabate M Cardiovascular Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Carrer del Rosselló, 149, Barcelona, Spain.
- Morice MC Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, Massy, France.
- Chevalier B Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, Massy, France.
- Windecker S Bern University Hospital, Freiburgstrasse 18, Bern, Switzerland.
- Onuma Y ThoraxCenter, Erasmus Medical Center, Doctor Molewaterplein 40, GD Rotterdam, The Netherlands.
- 2018-08-21
Published in:
- European heart journal. - 2018
Coronary Angiography
Coronary Artery Disease
Drug-Eluting Stents
Humans
Myocardial Revascularization
English
Aim
In current device trials, the values of angiographic late lumen loss (LLL) have become extremely low and the relationship between LLL and clinical endpoints has not been recently re-evaluated. The impact of LLL on target lesion revascularization (TLR) in a patient- and study-level analysis of contemporary coronary devices was investigated.
Methods and results
We performed a patient-level meta-analysis of seven randomized controlled trials including 2426 patients treated with first- and second-generation drug-eluting stents (DES) and a study-level meta-analysis of 40 studies including 19 199 patients treated with CE-marked DES. In the patient-level analysis, the probability regression curve showed an exponential relationship between in-stent LLL and 2-year incidence of TLR. The optimal cut-off value of LLL based on Youden's index for 2-year TLR event was 0.50 mm. In the Cox proportional hazard model, LLL >0.50 mm was independently associated with an increased incidence of TLR up to 4 years after angiographic follow-up {adjusted hazard ratio (HR) 6.62 [95% confidence interval (95% CI) 4.67-9.39], P < 0.001}. In the meta-regression analysis of the DES studies, pooled mean value of LLL was as low as 0.23 mm (95% CI 0.20-0.26), and there was a moderate correlation between the 1- and 5-year incidence of TLR and the percentage of the lesions with LLL >0.50 mm (R2 = 0.44, P < 0.001 at 1 year, R2 = 0.40, P < 0.001 at 5 years).
Conclusion
An angiographic LLL ≤0.50 mm was not predictive of the incidence of TLR whereas a LLL >0.50 mm was. Low LLL in contemporary device trials may not be a sufficiently discriminating parameter for the comparative evaluation of devices.
In current device trials, the values of angiographic late lumen loss (LLL) have become extremely low and the relationship between LLL and clinical endpoints has not been recently re-evaluated. The impact of LLL on target lesion revascularization (TLR) in a patient- and study-level analysis of contemporary coronary devices was investigated.
Methods and results
We performed a patient-level meta-analysis of seven randomized controlled trials including 2426 patients treated with first- and second-generation drug-eluting stents (DES) and a study-level meta-analysis of 40 studies including 19 199 patients treated with CE-marked DES. In the patient-level analysis, the probability regression curve showed an exponential relationship between in-stent LLL and 2-year incidence of TLR. The optimal cut-off value of LLL based on Youden's index for 2-year TLR event was 0.50 mm. In the Cox proportional hazard model, LLL >0.50 mm was independently associated with an increased incidence of TLR up to 4 years after angiographic follow-up {adjusted hazard ratio (HR) 6.62 [95% confidence interval (95% CI) 4.67-9.39], P < 0.001}. In the meta-regression analysis of the DES studies, pooled mean value of LLL was as low as 0.23 mm (95% CI 0.20-0.26), and there was a moderate correlation between the 1- and 5-year incidence of TLR and the percentage of the lesions with LLL >0.50 mm (R2 = 0.44, P < 0.001 at 1 year, R2 = 0.40, P < 0.001 at 5 years).
Conclusion
An angiographic LLL ≤0.50 mm was not predictive of the incidence of TLR whereas a LLL >0.50 mm was. Low LLL in contemporary device trials may not be a sufficiently discriminating parameter for the comparative evaluation of devices.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1093/eurheartj/ehy436
- PMID 30124834
- Persistent URL
- https://sonar.ch/global/documents/9991
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