title: Prognostic value of the modified American College of Cardiology/American Heart Association lesion morphology classification for clinical outcome after sirolimus-eluting stent placement (results of the prospective multicenter German Cypher Registry).
abstract: The modified American College of Cardiology/American Heart Association (ACC/AHA) lesion morphology classification scheme has prognostic impact for early and late outcomes when bare-metal stents are used. Its value after drug-eluting stent placement is unknown. The predictive value of this lesion morphology classification system in patients treated using sirolimus-eluting stents included in the German Cypher Registry was prospectively examined. The study population included 6,755 patients treated for 7,960 lesions using sirolimus-eluting stents. Lesions were classified as type A, B1, B2, or C. Lesion type A or B1 was considered simple (35.1%), and type B2 or C, complex (64.9%). The combined end point of all deaths, myocardial infarction, or target vessel revascularization was seen in 2.6% versus 2.4% in the complex and simple groups, respectively (p = 0.62) at initial hospital discharge, with a trend for higher rates of myocardial infarction in the complex group. At the 6-month clinical follow-up and after adjusting for other independent factors, the composite of cumulative death, myocardial infarction, and target vessel revascularization was nonsignificantly different between groups (11.4% vs 11.2% in the complex and simple groups, respectively; odds ratio 1.08, 95% confidence interval 0.8 to 1.46). This was also true for target vessel revascularization alone (8.3% of the complex group, 9.0% of the simple group; odds ratio 0.87, 95% confidence interval 0.72 to 1.05). In conclusion, the modified ACC/AHA lesion morphology classification system has some value in determining early complications after sirolimus-eluting stent implantation. Clinical follow-up results at 6 months were generally favorable and cannot be adequately differentiated on the basis of this lesion morphology classification scheme.
authors.affiliation: Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany. ahmed.khattab@segebergerkliniken.de
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Ralph
authors.initials: R
authors.lastname: Toelg
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.forename: Tassilo
authors.initials: T
authors.lastname: Bonzel
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Benny
authors.initials: B
authors.lastname: Levenson
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfannebecker
authors.forename: Georg
authors.initials: G
authors.lastname: Sabin
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Ulrich
authors.initials: U
authors.lastname: Tebbe
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
mesh_terms: D023921:Coronary Stenosis / Q000145:classification* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020123:Sirolimus / Q000008:administration & dosage*; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D019210:Troponin I; D020107:Troponin T; D020123:Sirolimus