title: Preintervention arterial remodeling as an independent predictor of target-lesion revascularization after nonstent coronary intervention: an analysis of 777 lesions with intravascular ultrasound imaging.
abstract: BACKGROUND
  Pathological and intravascular ultrasound (IVUS) studies have documented arterial remodeling during atherogenesis. However, the impact of this remodeling process on the long-term outcome after percutaneous intervention is unknown.
  
  
  RESULTS
  We used preintervention IVUS to define positive and negative/intermediate remodeling in a total of 777 lesions in 715 patients treated with nonstent techniques. Positive remodeling (lesion external elastic membrane area greater than average reference) was present in 313 lesions; intermediate/negative remodeling (lesion external elastic membrane area less than or equal to reference) was present in the other 464. Baseline clinical and angiographic characteristics were similar, except for a slightly higher percentage of insulin-dependent diabetic patients (10.2% versus 6.1%; P=0.054) in the negative/intermediate-remodeling group. Angiographic success and in-hospital and short-term complications were comparable in the 2 groups. There was no significant correlation between remodeling (as a continuous variable) and final lumen area (r=0.06) or final lesion plaque burden (r=0.17). At 18+/-13 months of clinical follow-up, both groups had similar rates of death and Q-wave myocardial infarction: 3.4% and 2.5% for the negative/intermediate-remodeling group versus 2.7% and 2.7% for the positive-remodeling group. However, the target-lesion revascularization (TLR) rate was 20.2% for the negative/intermediate-remodeling group versus 31.2% for the positive-remodeling group (P=0.007), and remodeling, as a continuous variable, was strongly correlated with probability of TLR (P=0.0001). By multivariable logistic regression analysis, diabetes (OR=2.3), left anterior descending artery location (OR=1.8), and remodeling (OR=5.9) were independent predictors of TLR.
  
  
  CONCLUSIONS
  Positive lesion-site remodeling is associated with a higher long-term TLR after a nonstent interventional procedure. Thus, long-term clinical outcome appears to be determined in part by preintervention lesion characteristics.
authors.affiliation: Cardiac Catheterization and Intravascular Ultrasound Imaging Laboratories, Washington Hospital Center, Washington, DC., USA.
authors.forename: G
authors.initials: G
authors.lastname: Dangas
authors.forename: G S
authors.initials: GS
authors.lastname: Mintz
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: A J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: R
authors.initials: R
authors.lastname: Kornowski
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: G W
authors.initials: GW
authors.lastname: Stone
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000628:therapy; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional