730 Prediction of type 4a myocardial infarction with the angiography-derived haemodynamic (added) index

Aims Percutaneous coronary intervention (PCI) is frequently complicated by type 4a myocardial infarction (MI). We assessed the usefulness of the angiography-derived haemodynamic index (ADDED) index in predicting type 4a MI in patients with chronic coronary syndrome (CCS) undergoing PCI. Methods and results We enrolled 442 patients treated with single-vessel PCI. The ADDED index was calculated as the ratio of the Duke Jeopardy Score (DJS) to the minimum lumen diameter (MLD) assessed with quantitative angiography analysis (QCA). Patients in the higher ADDED tertile presented higher occurrence of type 4a MI (17.7%, P < 0.0001). At ROC curve analysis, the ADDED index could significantly discriminate between patients with and without type 4a MI (area under the curve 0.745). At multivariate analysis, an ADDED index value >5.25 was the strongest independent predictor type 4a MI. Conclusions Our results support the role of the ADDED index as a predictor of type 4a MI in patients with CCS treated with elective PCI.

Drug-Coated Balloons versus Everolimus-Eluting Stents in Patients with In-Stent Restenosis: A Pair-Wise Meta-Analysis of Randomized Trials

Objective. This study aimed to compare the effectiveness of drug-coated balloons (DCB) with everolimus-eluting stents (EES) in the treatment of in-stent restenosis (ISR) and the differential relative effect of DCB in patients with drug-eluting stents (DES)-ISR and bare metal stents (BMS)-ISR. Background. The efficiency and safety of DCB and EES need to be assessed for the treatment of ISR. Methods. A systematic literature search was conducted using PubMed and EMBASE to identify all relevant studies. Angiographic results and clinical events were separately assessed. Subgroup meta-analyses were performed according to the type of restenosed stent. Results. Six randomized trials with 1134 patients were included. The overall pooled outcomes indicated that DCB was associated with lower minimum lumen diameter (mean difference MD=−0.17, 95% CI = −0.29 to −0.05, P=0.006) and higher target lesion revascularization (risk ratio RR=2.38, 95% CI = 1.36 to 4.18, P=0.002) than EES. However, the subgroup meta-analyses showed that DCB was inferior to EES only in DES-ISR patients, with lower minimum lumen diameter (MD=−0.25, 95% CI = −0.37 to −0.14, P<0.001), higher percent diameter stenosis (MD=5.37, 95% CI = 1.33 to 9.42, P=0.009), more binary restenosis (RR=2.07, 95% CI = 1.20 to 3.58, P=0.009), and higher incidence of target vessel revascularization (RR=2.07, 95% CI = 1.22 to 3.50, P=0.007) and target lesion revascularization (RR=2.43, 95% CI = 1.28 to 4.22, P=0.002). No differences in angiographic results and clinical events were found between DCB and EES in BMS-ISR patients. Conclusions. DCB was inferior to EES in DES-ISR and comparable in BMS-ISR in terms of angiographic results and clinical events.

EFFECTIVENESS OF ENDOVASCULAR TREATMENT OF IN-STENT RESTENOSIS AFTER SUCCESSFUL CHRONIC TOTAL CORONARY OCCLUSION RECANALIZATION

Aim. To assess the effectiveness of endovascular treatment of in-stent restenosis after successful chronic total coronary occlusion (CTO) recanalization.Methods. 117 patients who underwent successful CTO recanalization in the period from 2009 to 2012 were included in the study. All patients were referred to the elective examination including coronary angiography, intravascular ultrasound and optical coherence tomography within 6.1±0.9 months after the successful recanalization. If in-stent restenosis after CTO recanalization was confirmed and further endovascular treatment was performed, patients underwent repeat endovascular examination after 6.6±0.8 months. Сoronary artery lumen was evaluated at the sites of the performed intervention.Results. 18.8% of patients had in-stent restenosis, of them 95.5% underwent percutaneous coronary intervention. 76.2% of patients underwent high-pressure balloon predilatation, 4.8% of patients received paclitaxel-eluting balloons, 14.2% of patients – drug-eluting stents (DES), and 4.8% of patients - bare-metal stents. A significant increase of minimum lumen diameter after the percutaneous coronary intervention (from 0.8±0.5 mm to 2.2±0.3 mm, p<0.01) and a decrease of coronary artery lumen stenosis (from 67.9±18.3% to 19.7±8.8%, p<0.01) had been determined. There were no cases of death, acute myocardial infarction, acute strokes and target lesion thrombosis 6.6±0.8 months after the in-stent restenosis treatment. 52.8% of cases had repeat restenosis, including 56.3% of those who underwent high-pressure balloon predilatation and 33.3% of patients after DES implantation. The minimum lumen diameter decreased from 2.2±0.3 mm to 1.6±0.5 mm (p<0.01), and the degree of lumen stenosis increased from 19.7±8.8 mm2 to 41.5±17.3 mm2 (p<0.01).Conclusion. In-stent restenosis treatment after the successful CTO recanalization by the endovascular methods was effective in 47.2% of cases. DES and drug coated balloons can potentially reduce the rate of repeat restenosis.

A Novel Rotablator Technique (Low-Speed following High-Speed Rotational Atherectomy) Can Achieve Larger Lumen Gain: Evaluation Using Optimal Frequency Domain Imaging

Background. While the evaluation of burr speed was discussed regarding platelet aggregation, the association between platform speed and acute lumen gain of rotational atherectomy remains unknown. Methods. Through the evaluation of the potential of low-speed rotational atherectomy (LSRA) in in-vitro experiments, minimum lumen diameter (MLD) and minimum lumen area (MLA) after conventional high-speed rotational atherectomy (HSRA group) and those after LSRA following HSRA (LSRA+HSRA group) treated by 1.5 mm burrs were measured by optical frequency domain imaging (OFDI) in 30 consecutive human lesions. Results. The in-vitro experiments demonstrated that MLD and MLA after LSRA+HSRA were significantly larger (MLD: LSRA+HSRA=1.50 ±0.05 mm, HSRA= 1.43 ±0.05 mm, p=0.015; MLA: LSRA+HSRA= 1.90 ±0.17 mm2, HSRA= 1.71±0.11 mm2, and p= 0.037), requiring more crossing attempts (LSRA= 134 ±20 times, HSRA= 72 ±11 times, and p< 0.001). In human studies, there was no significance in reference vessel diameter and lesion length before the procedure between two groups. MLDs after LSRA+HSRA were significantly larger than those in HSRA (LSRA+HSRA= 1.22 ±0.16 mm, HSRA= 1.07 ±0.14 mm, and p= 0.0078), while MLAs after LSRA+HSRA tended to be larger (LSRA+HSRA= 1.79 ±0.51 mm2, HSRA= 1.55 ±0.47 mm2, and p= 0.19). There was no significance in the occurrence of in-hospital complication, including slow flow or no reflow, major dissection, and procedural myocardial infarction, between LSRA+HSRA and HSRA. Conclusions. LSRA can achieve larger lumen gain compared, whereas HSRA can pass calcified lesions easily. Combination of LSRA and HSRA is a safe and feasible strategy for severely calcified lesions in clinical practice.

Abstract 15463: Very Early Tissue Coverage After Drug-eluting Stent Implantation

Introduction: Optical coherence tomography (OCT) have demonstrated neointimal coverage on drug-eluting stents (DES) struts at 6-12 month follow-up. However, there is little information about tissue coverage <30 days after DES implantation. Methods: OCT was performed in patients who underwent staged percutaneous coronary intervention <30 days (16.3±7.5 days) after DES implantation. Cross-sectional OCT images of DES were analyzed at 1-mm intervals. Results: A total of 6,054 struts of 29 stents (27 everolimus-eluting stents and 2 zotarolimus-eluting stents) in 24 lesions were analyzed. The stent length was 32.8±9.47 mm, mean stent area 7.50±2.17 mm2, mean lumen area 7.39±2.35 mm2, minimum lumen area 5.69±1.90 mm2, and minimum lumen diameter 2.41±0.39 mm. Stent coverage was observed in 73.5±20.4% of the struts, malapposition 0.85±1.53%, side branch orifice struts 1.37±2.16%, and protruding struts 1.01±4.08%. The tissue thickness was 36.9 ± 14.5 μm. The percentage of stent coverage was significantly lower in the overlapping segments than in the non-overlapping segments (Figure). Conclusions: Most of DES struts are covered by tissue <30 days after EES implantation. However, the percentage of stent coverage is lower in the overlapping segments.

Abstract 367: Measurement of Lumen Dimensions in Non-stented and Stented Coronary Arteries: A Meta-analysis of Frequency Domain Optical Coherence Tomography versus Intravascular Ultrasound

Background: Intraluminal coronary morphology is traditionally evaluated by Intravascular Ultrasound (IVUS). Frequency Domain Optical Coherence Tomography (FD-OCT) is a novel method for evaluation of coronary lumen dimensions. Current literature has paucity of data with limited sample size comparing FD-OCT to IVUS. The objective of this meta-analysis is to compare the FD-OCT versus IVUS in assessment of lumen dimensions in non-stented and stented coronary arteries. Methods: PubMed and the Cochrane Center Register of Controlled Trials were searched through January 2015. Seven studies (n=169 vessels) comparing FD-OCT versus IVUS procedures in assessing lumen dimensions in non-stented and stented coronary arteries were included. Outcomes were minimum lumen area, minimum lumen diameter and maximum lumen diameter. The mean difference (MD) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance. Results: FD-OCT measured significantly smaller minimum lumen area and maximum lumen diameter compared to IVUS in non-stented vessels (MD: -0.86 mm 2 , CI: -1.18 to -0.55, p<0.00001 and MD: -0.21 mm, CI: -0.35 to -0.06, p=0.006, respectively). Minimum lumen diameter was not significantly different between two groups in non-stented coronary arteries (p=0.21). In stented vessels, no significant difference was found in measurement of minimum lumen area (p=0.34) and minimum lumen diameter (p=0.41) between FD-OCT and IVUS. Conclusion: The results of this study suggest that FD-OCT maybe a better modality to evaluate the severity of stenosis in non-stented coronary arteries. FD-OCT is comparable to IVUS in measuring lumen dimensions in stented vessels.

Abstract 17712: Comparison of Three-Dimensional and Two-Dimensional Quantitative Coronary Angiography and Intravascular Ultrasound for the Functional Assessment of Coronary Lesions

Introduction: Three-dimensional (3-D) quantitative coronary angiography (QCA) reportedly allows a more accurate depiction of true vessel geometry when compared with standard two-dimensional (2-D) QCA and has been validated by intravascular ultrasound (IVUS). Although IVUS is currently thought to provide the most accurate measurements of vessel geometry and lesion severity, 3-D QCA measurements can be performed on existing standard coronary angiography images without the need for additional time or equipment during the procedure. Hypothesis: We assessed the hypothesis that 3-D QCA measurements and IVUS are comparable in accuracy in predicting physiologically significant stenosis assessed by fractional flow reserve (FFR). Methods: Forty lesions in 38 patients were assessed by FFR, IVUS, and 2-D and 3-D QCA. Correlations between anatomical data and FFR were analyzed. The area under the receiver-operating characteristic (ROC) curve (AUC) was calculated to identify the accuracy of predicting FFR ≤0.80. Results: Mean FFR value was 0.75 ± 0.13. FFR ≤0.80 was observed in 26 lesions (65%). Of all measurements of lesion severity obtained by IVUS, minimum lumen diameter (MLD) (r = 0.80, p <0.001) and minimum lumen area (MLA) (r = 0.72, p <0.001) were well correlated with FFR values. Of all 3-D QCA measurements, MLA correlated best with FFR values (r = 0.75, p <0.001). Of all 2-D QCA measurements, MLD correlated best with FFR values (r = 0.58, p <0.001). The AUC were 0.95 for MLA by IVUS, 0.93 for MLD by IVUS, 0.93 for MLA by 3-D QCA, and 0.78 for MLD by 2-D QCA (Figure). Conclusions: Anatomical parameters obtained by 3-D QCA and IVUS correlate better with FFR values than those obtained by 2-D QCA. The predictive value of 3-D QCA for reduced FFR is comparable to IVUS measurements.

Angioscopic Evaluation of Stabilizing Effects of Bezafibrate on Coronary Plaques in Patients With Coronary Artery Disease

Background Since long-term administrations of anti-hyperlipidemic agents result in reduction in % stenosis or increase in minimum lumen diameter (MLD) of stenotic coronary segments, it is generally believed that anti-hyperlipidemic agents stabilize vulnerable coronary plaques. However, recent pathologic and angioscopic studies revealed that vulnerability of coronary plaques is not related to severity of stenosis and the rims rather than top of the plaques disrupt, and therefore, angiography is not adequate for evaluation of vulnerability.Angioscopy enables macroscopic pathological evaluation of the coronary plaques. Therefore, we carried out a prospective angioscopic open trial for evaluation of the stabilizing effects of bezafibrate on coronary plaques.Methods From April, 1997 to December, 1998, 24 patients underwent coronary angioscopy of the plaques in the non-targeted vessels during coronary interventions and 6 months later. The patients were divided into control (10 patients, 14 plaques) and bezafibrat (14 patients, 21 plaques) groups. Oral administration of bezafibrate (Bezatol SR, 400mg/day) was started immediately after the interventions and was continued for 6 months. The vulnerability score was determined based on angioscopic characteristics of plaques and it was compared before and 6 months later.Results Six months later, vulnerability score was reduced (from 1.6 to 0.8;p < 0.05) in bezafibrate group and unchanged (from 1.4 to 1.3; NS) in control group. In bezafibrate group, the changes in vulnerability score was not correlated with those in % stenosis or MLD. Conclusion The results indicate that bezafibrate can stabilize coronary plaques.