Long-Term Serial Angiographic Outcomes After Sirolimus-Eluting Stent Implantation

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Abstract

Objective

We evaluated, using quantitative coronary angiography, the natural history of change that occurred in target lesions after successful sirolimus-eluting stent (SES) implantation.

Background

Percutaneous coronary intervention with drug-eluting stents (DES) has significantly reduced the rate of repeated target lesion revascularization. However, early studies have raised concerns regarding the “late catch-up” phenomenon of DES.

Methods

Between June 2004 and March 2007, consecutive 217 patients with 306 lesions without restenosis at early angiographic follow-up underwent late angiographic follow-up (early follow-up: 11.2 ± 2.1 months and late follow-up: 29.4 ± 5.2 months). Predictors of late catch-up were identified with univariate and multivariate regression analyses.

Results

Although reference vessel diameter did not significantly change during follow-up [3.15 mm (interquartile range (IQR): 2.81–3.49 mm), 3.12 mm (IQR: 2.79–3.47 mm), and 3.08 mm (IQR: 2.76–3.46 mm) at postprocedure, and early and late angiographic follow-up, respectively;P= 0.2653], late loss (LL) significantly increased during follow-up [0.05 mm (IQR: 0.00–0.13 mm) and 0.08 mm (IQR: 0.01–0.19 mm) at early and late follow-up, respectively;P< 0.0001]. Univariate analysis showed previous intervention, adjunctive use of cutting balloon, lesion length, and progression of MLD, LL, %DS at early follow-up as predictors of late catch-up. Multivariate regression analysis identified %DS at early follow-up as a predictor of late catch-up (OR 1.076, CI 1.039–1.114,P< 0.0001).

Conclusion

Significant and continuous progression of neointima after SES implantation was observed in the present study. Larger LL may be a sign of late catch-up phenomenon.

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