title: Predictors and implications of residual plaque burden after coronary stenting: an intravascular ultrasound study.
abstract: BACKGROUND
  Residual plaque burden after coronary stenting may be visualized by use of intravascular ultrasound. Determinants and implications of residual atherosclerotic plaque burden after coronary stenting are not well established. In particular, the implications of residual plaque burden, after adjusting for confounding factors, are still unknown.
  
  
  METHODS
  Sixty-two consecutive patients (age 56 +/- 9 years) undergoing coronary stenting under intravascular ultrasound imaging guidance were prospectively studied. A total of 616 slices were analyzed (every 2 mm of stent length) from motorized pull-back recordings. Residual plaque burden was calculated as residual plaque/vessel area x 100.
  
  
  RESULTS
  In 565 slices (89%), both residual plaque area and stent area could be measured. Mean residual plaque burden was 46.5% +/- 6%. By use of multiple regression analysis, lesion plaque area and reference segment plaque burden were identified as independent predictors of residual plaque burden after stenting. In addition, a significant correlation was found between residual plaque burden and most relevant angiographic parameters at follow-up (including minimal lumen diameter, percent diameter stenosis, and loss index), which persisted after adjustment. Furthermore, stents with a residual plaque burden >or=46% had higher a restenosis rate (relative risk [RR] 4.4, 95% CI 1.09-18.2, P =.03). On logistic regression analysis, residual plaque burden (RR 4.8, 95% CI 4.1-5.6, P =.01) and diabetes (RR 4.3, 95% CI 3.6-5.1, P =.03) emerged as the only independent predictors of restenosis.
  
  
  CONCLUSIONS
  The amount of residual plaque burden after coronary stenting plays an independent role on the late angiographic outcome of these patients.
authors.affiliation: Interventional Cardiology Unit, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Pablo
authors.initials: P
authors.lastname: García
authors.forename: Gela
authors.initials: G
authors.lastname: Pimentel
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D011859:Radiography; D012044:Regression Analysis; D015607:Stents; D016019:Survival Analysis; D018084:Ultrasonography, Interventional