Differential outcome after intracoronary radiation therapy is related to a simple classification based on lesion length and reference diameter.
OBJECTIVE
We sought to develop a prognostic lesion classification based on simple angiographic parameters, lesion length and reference diameter that predicts differential outcome in patients undergoing intracoronary radiation.


RESULTS
Three types of lesions were identified: Type A characterized by lesion length less than or equal to 30 mm, reference diameter > 2.5 mm to less than or equal to 4.0 mm (short lesion: normal diameter), Type B by lesion length less than or equal to 30 mm, reference diameter less than or equal to 2.5 mm or > 4 mm (short lesion: extreme diameter), and Type C by lesion length > 30 mm (long lesion). A total of 1,151 lesions (77.7% in-stent restenosis) in 1,098 consecutive patients undergoing brachytherapy were classified into these 3 lesion types. Overall, 79.9%, 10.3% and 9.8% patients met the criteria for Type A, B and C lesions. While the in-hospital major adverse cardiac event (MACE) rate was 1.4%, 3.6% and 3.8% (p = 0.026), the 6-month MACE rate was 16.1%, 22.5% and 32.1% (p < 0.001), the angiographic restenosis rate was 21.3%, 32.4% and 42.4% (p < 0.001), and the late thrombosis rate was 4.1%, 9.0% and 11.3%, (p < 0.001) in Type A, B and C lesions, respectively. Consequently, with increasing lesion severity, 3 risk groups with low, medium and high risk were defined. Multivariate analysis showed that Type B and C lesions were independent predictors of 6-month MACE (OR, 1.5 and 1.9, respectively).


CONCLUSIONS
The proposed novel and easily applicable lesion classification effectively predicts early and medium term outcome, and may be used for appropriate therapeutic decision making in patients undergoing brachytherapy.
Jain
Deepak
D
Medizinische Klinik II, Ratzenburger Allee 160, Lubeck, Germany. jain.deepak@innere2.uni-luebeck.de
Wegscheider
Karl
K
Hartmann
Franz
F
Bonan
Raoul
R
Urban
Philip
P
Schunkert
Heribert
H
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000145:classification* / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D003331:Coronary Vessels / Q000528:radiation effects; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D011859:Radiography; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome