Visual assessment of procedural results following treatment with Sr-90 beta-radiation for instent restenosis.
BACKGROUND
Visual assessment (VA) of postprocedural % diameter stenosis (DS) is used routinely in clinical practice to determine the adequacy of coronary intervention. Although VA has been shown to underestimate final %DS after balloon angioplasty compared to quantitative coronary angiography (QCA), the impact of this effect on clinical outcomes following treatment with intracoronary radiation therapy (IRT) with Sr-90 for instent restenosis (ISR) is unknown.


METHODS
To determine the effect of VA on the rate of major adverse cardiac events (MACEs) after IRT for ISR, we compared the clinical outcomes of 102 consecutive patients based on postprocedural %DS by QCA vs. %DS by VA. MACE was defined as death, M1 or need for target vessel revascularization (TVR).


RESULTS
MACE rates for the 102 consecutive patients grouped according to postprocedural %DS by QCA and VA were compared. The mean %DS by QCA was 30.7%, while the mean %DS by VA was 12.5%. The mean %DS by VA across the QCA subgroups were 13.67%, 10.71% and 13.37%, respectively (P = .244). Fifty-two patients (51.0%) had %DS > 30% by QCA with the highest MACE percentage occurring in this subgroup.


CONCLUSIONS
VA underestimated the %DS compared to QCA, and it was associated with worse MACE following treatment with Sr-90 for ISR.
Chua
Dave C Y
DC
Rush Heart Institute, Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, Chicago, IL 60612, USA.
Almeda
Francis Q
FQ
Senter
Shaun
S
Kim
Susie
S
Bromet
David S
DS
Butzel
David
D
Nguyen
Cam
C
Chu
James C H
JC
Kavinsky
Clifford J
CJ
Snell
R Jeffrey
RJ
Schaer
Gary L
GL
D001610:Beta Particles / Q000627:therapeutic use*; D017023:Coronary Angiography; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012086:Reoperation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013326:Strontium Radioisotopes / Q000627:therapeutic use; D015996:Survival Rate; D014796:Visual Perception
D013326:Strontium Radioisotopes