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Multicenter Study
. 2021 Aug 9;14(15):1639-1650.
doi: 10.1016/j.jcin.2021.05.019.

Stent Expansion Indexes to Predict Clinical Outcomes: An IVUS Substudy From ADAPT-DES

Tatsuhiro Fujimura  1 , Mitsuaki Matsumura  2 , Bernhard Witzenbichler  3 , D Christopher Metzger  4 , Michael J Rinaldi  5 , Peter L Duffy  6 , Giora Weisz  1 , Thomas D Stuckey  7 , Ziad A Ali  8 , Zhipeng Zhou  2 , Gary S Mintz  2 , Gregg W Stone  9 , Akiko Maehara  10
Affiliations
Free article
Multicenter Study

Stent Expansion Indexes to Predict Clinical Outcomes: An IVUS Substudy From ADAPT-DES

Tatsuhiro Fujimura et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to evaluate various stent expansion indexes to determine the best predictor of clinical outcomes.

Background: Numerous intravascular ultrasound (IVUS) studies have shown minimum stent area (MSA) to be the most powerful predictor of future events.

Methods: ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, multicenter registry of 8,582 patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents. Native coronary artery lesions treated with IVUS-guided PCI with final analyzable IVUS were included. Ten stent expansion indexes (MSA, MSA/vessel area at MSA site, conventional stent expansion [MSA/average of proximal and distal reference luminal area], minimum stent expansion using Huo-Kassab or linear model accounting for vessel tapering, stent asymmetry [minimum/maximum stent diameter within the entire stent], stent eccentricity [smallest minimum/maximum stent diameter at a single slice within the stent], IVUS-XPL [Impact of intravascular Ultrasound Guidance on Outcomes of Xience Prime Stents in Long Lesions] criteria, ULTIMATE [Intravascular Ultrasound Guided Drug Eluting Stents Implantation in "All-Comers" Coronary Lesions] criteria, and ILUMIEN IV criteria) were evaluated for their associations with lesion-specific 2-year clinically driven target lesion revascularization (TLR) or definite stent thrombosis.

Results: Overall, 2,140 lesions in 1,831 patients were included; final MSA measured 6.2 ± 2.4 mm2. Among the 10 stent expansion indexes, only MSA/vessel area at the MSA site was independently associated with 2-year clinically driven TLR or definite stent thrombosis (hazard ratio: 0.77; 95% confidence interval: 0.59-0.99; P = 0.04) after adjusting for morphologic and procedural parameters.

Conclusions: In this IVUS-guided PCI cohort with excellent final MSA overall, stent/vessel area at the MSA site, an index of relative stent expansion, was superior to absolute MSA and other expansion indexes in predicting 2-year clinically driven TLR or definite stent thrombosis.

Keywords: drug-eluting stent(s); intravascular ultrasound; major adverse cardiac event(s); minimum stent area; percutaneous coronary intervention.

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Conflict of interest statement

Funding Support and Author Disclosures The ADAPT-DES study was sponsored by the Cardiovascular Research Foundation, with funding provided by Boston Scientific, Abbott Vascular, Medtronic, Cordis, Biosensors, The Medicines Company, Daiichi-Sankyo, Eli Lilly, Volcano, and Accumetrics. Dr Matsumura is a consultant for Terumo. Dr. Metzger has received symposium honoraria from Abbott Vascular and Boston Scientific. Dr Rinaldi is an advisory board member for Abbott, Boston Scientific, Cordis, and 4C Medical; has taught courses for Abbott and Edwards Lifesciences; is a consultant for Abbott, Boston Scientific, Edwards Lifesciences, and Cordis; and has received research and grant support from Boston Scientific. Dr Duffy is a consultant and speaker for Philips Medical/Volcano. Dr Weisz has received consulting fees from Filterlex, Intratech, and Magenta; holds stock options in Filterlex, Intratech, Magenta, Medivizer, Trisol, and Vectorious; and has received honoraria from Cardiovascular Systems. Dr Stuckey is an advisory board member for Boston Scientific; and has received speaker honoraria from Boston Scientific and Eli Lilly/Daiichi-Sankyo. Dr Ali has received institutional research grants to Columbia University from Abbott, Cardiovascular Systems; is a consultant for Amgen, AstraZeneca, and Boston Scientific; and holds equity in Shockwave Medical. Dr. Mintz has received honoraria from Boston Scientific, Philips, Terumo, and Medtronic. Dr Stone has received speaker or other honoraria from Cook, Terumo, Qool Therapeutics, and Orchestra Biomed; is a consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme, CardioMech; and holds equity or options in Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, the Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, the MedFocus family of funds, and Valfix. Dr Maehara has received grant support from and is a consultant for Abbott Vascular and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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