Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents

Witzenbichler, Bernhard; Maehara, Akiko; Weisz, Giora; Neumann, Franz Josef; Rinaldi, Michael; Metzger, D. Christopher; Henry, Timothy D.; Cox, David A.; Duffy, Peter L.; Brodie, Bruce R.; Stuckey, Thomas; Mazzaferri, Ernest L.; Xu, Ke; Parise, Helen; Mehran, Roxana; Mintz, Gary S.; Stone, Gregg W.

doi:10.1161/circulationaha.113.003942

Cited by 364 publications

(115 citation statements)

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“…In addition and as previously reported, IVUS‐detected ASM was typically corrected with additional balloon dilations10; and ADAPT‐DES did not contain a blinded IVUS arm in which the findings were hidden from the interventionalists. Therefore, the current prevalence of ASM may be less than in patients treated with angiographic guidance alone.…”

Section: Discussionmentioning

confidence: 79%

“…In a previous report from ADAPT‐DES, IVUS guidance was associated with a reduction in stent thrombosis, MI, and MACE within 1 year after DES implantation 10. The current study used the IVUS data from ADAPT‐DES to assess the impact of residual ASM on late events.…”

Section: Discussionmentioning

confidence: 99%

“…The design, major inclusion and exclusion criteria, end points, and definitions from the ADAPT‐DES study have been previously described in detail 9, 10. In brief, ADAPT‐DES was a prospective, multicenter, observational study of consecutive patients who were treated successfully with 1 or more US Food and Drug Administration‐ or CE mark‐approved DES regardless of patient or lesion complexity.…”

Section: Methodsmentioning

confidence: 99%

“…In the present analysis, major adverse cardiac events (MACE) included cardiac death, myocardial infarction (MI), and stent thrombosis, as defined previously by the Academic Research Consortium and as adjudicated by an independent clinical events committee 9, 10, 11. Clinically driven target lesion revascularization (TLR) was site reported, but not centrally adjudicated.…”

Section: Methodsmentioning

confidence: 99%

“…In a prespecified, prospective intravascular ultrasound (IVUS) substudy, culprit lesions were evaluated and treated using IVUS‐guided PCI 10. The aims of this substudy using the IVUS data from ADAPT‐DES were to (1) determine the prevalence of IVUS‐detected ASM in the current DES era after IVUS‐guided PCI; (2) evaluate the morphological features of ASM; (3) determine the predictors for ASM; and (4) clarify outcomes related to IVUS‐detected ASM, in particular the impact of ASM on stent thrombosis after IVUS‐guided PCI.…”

Section: Introductionmentioning

confidence: 99%

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Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Wang

Mintz

Witzenbichler

et al. 2016

JAHA

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BackgroundThe impact of acute stent malapposition (ASM) on long‐term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long‐term clinical outcomes of ASM.Methods and Results ADAPT‐DES (Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug‐eluting stents. In a prespecified intravascular ultrasound–guided substudy, 2072 patients with 2446 culprit lesions had post–percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound–guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug‐eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in‐stent lumen areas, larger stent areas, and larger in‐stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2‐year follow‐up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2‐year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model.ConclusionsIn patients treated with intravascular ultrasound–guided drug‐eluting stents implantation, ASM was not associated with adverse clinical events during long‐term follow‐up including, but not limited to, stent thrombosis.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%