title: Revisiting late loss and neointimal volumetric measurements in a drug-eluting stent trial: analysis from the SPIRIT FIRST trial.
abstract: This study was conducted to reevaluate the significance of angiographic late loss and to assess the agreement between new proposed neointimal volumetric measurements derived from quantitative coronary angiography (QCA) and standard intravascular ultrasound (IVUS)-based parameters. Neointimal volumetric measurements may better estimate the magnitude of neointimal growth after stenting than late loss. In 56 in-stent segments (27, everolimus; 29, bare metal) in the SPIRIT FIRST study, we compared QCA measures with the corresponding IVUS parameters. Two IVUS-late loss models were derived from minimal luminal diameter (MLD) using either a circular model or a so-called projected MLD. QCA-neointimal volume was calculated as follows: stent volume (mean area of the stented segment x stent length) at post procedure - lumen volume (mean area of the stented segment x stent length) at follow-up (the stent length either from nominal stent length or the length measured by QCA). Videodensitometric neointimal volume was also evaluated. Each of the three neointimal volume and percentage volume obstruction by QCA showed significant correlation with the corresponding IVUS parameters (r = 0.557-0.594, P < 0.0001), albeit with a broad range of limits of agreement. Late loss and volumetric measurements by QCA had a broader range of standard deviation than those by IVUS. QCA-volumetric measurements successfully confirmed the efficacy of everolimus-eluting stents over bare metal stents (P < 0.05). Our proposed QCA volumetric measurements may be a practical surrogate for IVUS measurements and a discriminant methodological approach for assessment of treatment effects of drug-eluting stents.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tsuchida
authors.forename: Héctor M
authors.initials: HM
authors.lastname: García-García
authors.forename: Andrew T L
authors.initials: AT
authors.lastname: Ong
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Jiro
authors.initials: J
authors.lastname: Aoki
authors.forename: Tessa A M
authors.initials: TA
authors.lastname: Rademaker
authors.forename: Marie-Angèle M
authors.initials: MA
authors.lastname: Morel
authors.forename: Gerrit-Anne
authors.initials: GA
authors.lastname: van Es
authors.forename: Nico
authors.initials: N
authors.lastname: Bruining
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D016503:Drug Delivery Systems; D000068338:Everolimus; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015607:Stents; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus