The natural course of nonculprit coronary artery lesions; analysis by serial quantitative coronary angiography View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-06-28

AUTHORS

Jeehoon Kang, Kyung Woo Park, Michael S. Lee, Chengbin Zheng, Jung-Kyu Han, Han-Mo Yang, Hyun-Jae Kang, Bon-Kwon Koo, Hyo-Soo Kim

ABSTRACT

BackgroundNonculprit lesions are the major cause of future cardiovascular events. However, the natural course of nonculprit lesions and angiographic predictors of plaque progression are not well-studied. The purpose of our study was to observe the natural course of nonculprit lesions, and to identify predictors of unanticipated future events and angiographic progression in nonculprit lesions.MethodsWe analyzed 640 nonculprit lesions with a length of ≥2 mm and luminal narrowing ≥30% from 320 patients who had two serial angiographic follow-ups; 9 to 13 months post-PCI and 24 months post-PCI. The study endpoints were nonculprit-ischemia driven revascularization (IDR) and the rate of diameter stenosis (DS) progression. Those with progression of DS > 12%/year were defined as ‘rapid progressors’.ResultsDuring the median follow-up period of 737 days, 20 lesions in 20 patients (6.3%) required nonculprit-IDR. Independent predictors of nonculprit-IDR were diabetes (hazard ratio [HR] 2.93, 95% confidence interval [CI] 1.072–8.007, p = 0.036) and lesion type B2/C (HR 4.017, 95% CI 1.614–9.997, p = 0.003). The presence of one or both of the two major risk factors was associated with significant DS progression (3.0 ± 6.8% vs. 3.5 ± 6.1% vs. 6.8 ± 9.9% for lesions with 0, 1 and both risk factors, p < 0.001). Among the 640 lesions, 38 lesions (5.9%) in 33 patients were rapid progressors, while risk factors of rapid progressors included lesion type B2/C as a lesion-related risk factor (HR 1.998, 95% CI 1.006–3.791, p = 0.048) and diabetes mellitus as a patient-related risk factor (HR 3.725, 95% CI 1.937–7.538, p < 0.001). Lesions with both risk factors (type B2/C lesions in diabetic patients) were at the highest risk of rapid progression (odds ratio 3.250, 95% CI 1.451–7.282), compared to type A/B1 lesions in non-diabetic patients.ConclusionNonculprit-IDR was not uncommon during the 2-year follow up period in our population. The major risk factors of nonculprit lesion progression were diabetes and lesion type B2/C.Trial registrationRetrospectively registered and approved by the institutional review board of Seoul National University Hospital (No.: 1801–138-918) on February 2nd, 2018. More... »

PAGES

130

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12872-018-0870-9

DOI

http://dx.doi.org/10.1186/s12872-018-0870-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1105196836

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29954346


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46 angiography
47 artery lesions
48 board
49 cardiovascular events
50 cause
51 coronary angiography
52 coronary artery lesions
53 course
54 days
55 diabetes
56 endpoint
57 events
58 factors
59 follow
60 future cardiovascular events
61 future events
62 high risk
63 hospital
64 independent predictors
65 institutional review board
66 length
67 lesion progression
68 lesion-related risk factors
69 lesions
70 luminal narrowing
71 major cause
72 major risk factor
73 median follow
74 mellitus
75 months
76 narrowing
77 natural course
78 non-diabetic patients
79 nonculprit lesions
80 patient-related risk factors
81 patients
82 period
83 plaque progression
84 population
85 predictors
86 presence
87 progression
88 progressors
89 purpose
90 quantitative coronary angiography
91 rapid progression
92 rapid progressors
93 rate
94 revascularization
95 review board
96 risk
97 risk factors
98 serial quantitative coronary angiography
99 stenosis progression
100 study
101 study endpoint
102 trials
103 type B2/C
104 type B2/C.
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