Ten-year clinical outcomes of an intermediate coronary lesion; prognosis and predictors of major adverse cardiovascular events. (15th January 2020)

• Record Type: Journal Article
• Authors: Bae, Jang-Ho; Corban, Michel T.; Seo, Young-Hoon; Kim, Taewon; Lee, Gahyeong; Kwon, Taek-Geun; Kim, Ki-Hong; Song, In-Geol; Lee, Moo-Sik; Rihal, Charanjit S.; Lerman, Amir
• Is Part Of: International journal of cardiology. Volume 299(2020)
• Page Start: 26
• Page End: 30
• Publication Date: 2020-01-15
• Subjects: Coronary artery stenosis -- Intermediate coronary lesion -- Intravascular ultrasonography -- Prognosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.06.076
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: The natural history of intermediate coronary lesions (30 to 70% angiographic stenosis) and the prognostic predictors in predicting very long-term clinical outcomes is unknown. Methods: Patients (n = 82, mean 60 years old) with intermediate non-culprit coronary lesions (NCL, n = 86), evaluated by virtual histology-intravascular ultrasound (VH-IVUS), were followed for 10 years. Major adverse cardiovascular events (MACE; all-cause death, myocardial infarction, stroke, and revascularization) were collected over follow-up period and stratified by culprit lesion (CL)-related, NCL-related and indeterminate/unrelated to CL or NCL lesions. NCL-related MACE was further stratified into intermediate and minimal NCL-related events. Results: Twenty two (25.6%) out of 86 intermediate NCL were associated with MACE in 20/82 (24.4%) study patients. Ten-year cumulative intermediate NCL-related MACE rate was twice (25.6% vs. 12.8%) compared to treated culprit lesion (CL)-related MACE. Ten-year cumulative revascularization rate of the intermediate NCL lesions was similar (17.4% vs. 15.1%) to those of CL, but higher than that of minimal (stenosed <30% at baseline) NCL (8.1%). Important intermediate NCL VH-IVUS predictor for MACE was area stenosis ≥50%, and for revascularization were percent diameter stenosis, plaque burden ≥70%, and fibrofatty area. Conclusions: Ten-year MACE rate of intermediate NCL was double that of CL and ten-year revascularization rate of intermediate NCL was similar or slightly higher than that of CL. VH-IVUS may play an important role in determining the very long-term clinical outcomes in patients with intermediate NCL. This study suggests that Intermediate NCL can be safely followed up in terms of revascularization risk. Highlights: Ten--year MACE rate of intermediate non-culprit lesion (NCL) was double (25.6% vs. 12.8%) that of treated culprit lesion (CL) and ten-year revascularization rate of intermediate NCL was similar or slightly higher (17.4% vs. 15.1%) than that of CL. This study suggests that Intermediate NCL can be safely followed up in terms of revascularization risk.