Optimal threshold of postintervention minimum stent area to predict in-stent restenosis in small coronary arteries: An optical coherence tomography analysis.
OBJECTIVE
The aim of this study was to determine the best threshold of postintervention minimum stent area (MSA) assessed by optical coherence tomography (OCT) to predict long-term in-stent restenosis (ISR) for 2.5 mm-diameter everolimus-eluting stents (EES).


BACKGROUND
Percutaneous coronary intervention (PCI) for small coronary arteries remains challenging. Stent underexpansion is a strong predictor of late ISR.


METHODS
We performed a retrospective analysis of 69 lesions in 69 patients undergoing PCI with 2.5 mm-diameter stents using OCT for the assessment of postintervention MSA and subsequent 9-month angiographic follow-up.


RESULTS
The rates of angiographic ISR and target lesion revascularization were 7.2% and 1.4%. The postintervention OCT-MSA of EES < 3.5 mm(2) for predicting ISR yielded a sensitivity of 80%, specificity of 71%, positive predictive value of 18%, and negative predictive value of 98%. There was a marginally significant trend between increasing MSA quartiles and decreasing ISR rate (P for trend = 0.07).


CONCLUSIONS
Postintervention OCT-MSA of 3.5 mm(2) best predicted 9-month ISR following PCI with 2.5-mm-diameter EES. Further large, prospective, observational studies are warranted that validate this result. © 2015 Wiley Periodicals, Inc.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Yoshiki
Y
Matsuo
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Takashi
T
Kubo
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Hiroshi
H
Aoki
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Keisuke
K
Satogami
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Yasushi
Y
Ino
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Hironori
H
Kitabata
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Akira
A
Taruya
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Tsuyoshi
T
Nishiguchi
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Ikuko
I
Teraguchi
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Kunihiro
K
Shimamura
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Yasutsugu
Y
Shiono
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Makoto
M
Orii
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Takashi
T
Yamano
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Takashi
T
Tanimoto
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Tomoyuki
T
Yamaguchi
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Kumiko
K
Hirata
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Atsushi
A
Tanaka
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Takashi
T
Akasaka
D000368:Aged; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*
D007166:Immunosuppressive Agents; D000068338:Everolimus
everolimus-eluting stent; minimum stent area; optical coherence tomography; small vessel