Declaration of conflict of interest. Nothing to disclose

Transcription

1 Declaration of conflict of interest Nothing to disclose

2 Hong-Seok Lim, Seung-Jea Tahk, Hyoung-Mo Yang, Jin-Woo Kim, Kyoung- Woo Seo, Byoung-Joo Choi, So-Yeon Choi, Myeong-Ho Yoon, Gyo-Seung Hwang, Joon-Han Shin Department of Cardiology Ajou University Medical Center

3 Intravascular ultrasound (IVUS) provides useful information during stent implantation to optimize stent expansion, extension, and apposition; and to identify and treat possible complications after stent implantation. Mintz GS et al., J Am Coll Cardiol 2001;37: Hanekamp CE et al., Circulation 1999;99: MSA 5.0 mm 2 MSA 5.5 mm 2 MSA 6.0 mm 2 Sonoda S, et al., J Am Coll Cardiol 2004;43: Hong MK, et al., Eur Heart J 2006;27: E, et al., Am J Cardiol 2005;95:

4 FFR is useful and comparable to IVUS to guide optimal stent implantation. % Adverse Events at 6 Months Hanekamp CE, et al., Circulation 1999;99; % 22% 30% 30 % 20 % No. of patients AE at 6 mo N % % % 44 % event Pijls NH, et al., Circulation 2002;105;

5 FFR for 1yroutcomes after DES implantation Nam CW, et al., Am J Cardiol 2011;107:

6 In the current era of DES, the relationship between post-pci IVUS or FFR findings and long-term clinical outcomes the comparative value of post-pci IVUS and FFR as a guide to stent optimization related with favorable long-term clinical outcomes

7 To investigate and compare the predictive value of post-stent FFR and IVUS for longterm clinical outcomes after DES implantation.

8 Inclusion Criteria Both FFR and IVUS after elective PCI with DES Age years Stable angina, unstable angina, silent ischemia de novo coronary artery stenotic lesion ( 30% DS by visual estimation) Reference vessel diameter 2.5 mm by visual estimation Exclusion Criteria Acute MI Infarct-related artery in old MI LM disease In-stent restenosis / Graft vessel disease Low ejection fraction (< 40%) 206 lesions of 188 patients Composite of Cardiac 2 years

9 IVUS Galaxy2 and ilab IVUS Imaging System EchoPlaque 3.0 (Indec Systems, Mountain View, CA) Measurement of FFR Intracoronary Pressure Wire, RADI (St. Jude Medical, USA) RADI view 2.2

10 Baseline Characteristics (n=188) Male sex, n (%) 128 (62%) Age, y 60±10 Hypertension, n (%) 117 (62%) Diabetes, n (%) 55 (29%) Hyperlipidemia, n (%) 143 (76%) Current Smoking, n (%) 33 (18%) Clinical presentation, n (%) Stable angina, n(%) 86 (46%) Unstable angina, n(%) 89 (47%) Silent ischemia, n(%) 13 (7%) Previous MI, n(%) 7 (4%) Previous PCI or CABG, n(%) 18 (10%) Number of diseased vessel, 1 / 2 / 3 92 (49%) / 58 (31%) / 38 (20%) Medications at discharge DAPT / BB / RAS blockers /Statins, % 100 / 34 / 38 / 71

11 Angiographic and procedural characteristics Treated vessel, LAD / LCx / RCA 172 (84%) / 11 (5%) / 23 (11%) AHA/ACC lesion type B2/C 184 (89%) Reference vessel diameter, mm 3.5±1.7 Minimal lumen diameter, mm Pre-PCI 0.9±0.6 Post-PCI 3.2±1.7 Percent diameter stenosis, % 73±13 Lesion length, mm 25±6 Number of stent used per lesion 1.4±0.6 Stent length, mm 36±16 Mean diameter of stent 3.3±0.3 Types of stent, 1 st gen. / 2 nd gen 152(74%) / 54(26%)

12 IVUS and FFR findings Proximal reference segment EEM CSA, mm ±4.1 Lumen CSA, mm ±2.9 Distal reference segment EEM CSA, mm 2 9.0±4.1 Lumen CSA, mm 2 6.3±2.7 Pre-PCI MLA, mm 2 2.8±0.9 Plaque burden, % 77±9 Final minimum stent CSA, mm 2 6.2±1.6 Stent symmetricity index 0.84±0.08 FFR, Pre- / Post-PCI 0.75±0.11 / 0.91±0.05

13 12 events (6.4%) C-Death, 2 No MI TVR, 11 ROC analysis of MSA by IVUS and FFR for the prediction of clinical events 100 Post-stent FFR 100 Minim al stent area Sensitivity FFR > 0.92 AUC : % CI [ ] 20 MSA > 6.1mm 2 AUC : % CI [ ] Specificity 100-Specificity

14 Diagnostic value of post-pci MSA by IVUS and FFR to predict 2-year clinical outcomes MSA>6.1 mm 2 MSA 6.1 mm 2 FFR > 0.92 FFR 0.92 Cardiac events (+) Cardiac events (-) Sensitivity 75 % 100 % Specificity 46 % 43 % PPV 9 % 11 % NPV 96 % 100 %

15 Summary In the patients underwent DES implantation optimized by IVUS and FFR after stenting, the rate of cardiac events at 2- year was low. The accuracy of both poststent MSA and FFR for predicting 2- year outcomes after DES implantation were not satisfactory with no difference between the two diagnostic methods. Both poststent MSA and FFR can provide useful information for long-term outcomes with its high NPV.

16 Limitations Registry data Small number of events Need for prospective randomized comparison between IVUS and FFR

17 Conclusion Both post-stent FFR and IVUS MSA are useful on-site predictors for long-term outcomes after DES implantation with excellent negative predictive values.

18

19 Concordance between the BCV of post-pci MSA and FFR to predict 2-year clinical outcomes MSA>6.1 mm 2 MSA 6.1 mm 2 FFR > FFR Concordance 125/206 (61%)

20 1 st generation stent only 100 FFR 100 MSA Sensitivity Sensitivity Specif icity Specif icity Sensitivity FFR MSA Specif icity

21 LAD only 100 FFR 100 MSA Sensitivity Sensitivity Specif icity Specif icity Sensitivity FFR MSA Specif icity