title: Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation: An ADAPT-DES Intravascular Ultrasound Substudy.
abstract: Intravascular ultrasound detects stent edge dissections after percutaneous coronary intervention that are not seen angiographically. This study investigated the association between stent edge dissections and clinical outcomes.
  
  
  
  ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a large-scale, prospective, multicenter study of patients undergoing drug-eluting stent implantation. In this prospective substudy, 2062 patients (2433 lesions) were evaluated with intravascular ultrasound to characterize the morphological features and clinical outcomes of stent edge dissection after percutaneous coronary intervention. The prevalence of post-percutaneous coronary intervention stent edge dissection was 6.6% per lesion (161 of 2433). Calcified plaque at the proximal stent edge (relative risk [RR]=1.72; P=0.04) and proximal stent edge expansion (RR=1.18; P=0.004) were predictors for proximal dissection; attenuated plaque at the distal stent edge (RR=3.52; P=0.004), distal reference plaque burden (RR=1.56; P<0.0001), and distal edge stent expansion (RR=1.11; P=0.02) were predictors for distal dissection. At 1-year follow-up, target lesion revascularization was more common in lesions with versus without dissection (5.2% versus 2.7%; P=0.04). Multivariable analysis indicated that residual dissection was associated with target lesion revascularization at 1-year follow-up (RR=2.67; P=0.02). Among lesions with dissection, smaller effective lumen area increased the risk of target lesion revascularization at 1-year follow-up (cutoff value of 5.1 mm(2); P=0.05).
  
  
  
  Greater stent expansion and the presence of large, calcified, and/or attenuated plaques were independent predictors of stent edge dissection. Residual stent edge dissection, especially with a smaller effective lumen area, was associated with target lesion revascularization during 1-year follow-up after drug-eluting stent implantation.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: D Christopher
authors.initials: DC
authors.lastname: Metzger
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rinaldi
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Peter L
authors.initials: PL
authors.lastname: Duffy
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Rupa
authors.initials: R
authors.lastname: Parvataneni
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (N.K., G.S.M., G.W., R.P., A.J.K., G.W.S., A.M.); NewYork-Presbyterian Hospital/Columbia University Medical Center (N.K., G.W., A.J.K., G.W.S., A.M.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.). amaehara@crf.org.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016009:Chi-Square Distribution; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: angiography; dissection; drug-eluting stent; prevalence; stent