Background-The pattern of saphenous vein graft(SVG) calcification before percutaneous intervention has not been studied. Methods and Results-We used diagnostic and preintervention intravascular ultrasound(IVUS) to det...Background-The pattern of saphenous vein graft(SVG) calcification before percutaneous intervention has not been studied. Methods and Results-We used diagnostic and preintervention intravascular ultrasound(IVUS) to determine the incidence and magnitude of SVG calcification in 334 SVG lesions in 274 consecutive patients. Calcium was found in 133 SVGs(40%). Calcium was uniformly distributed among 48 lesion sites(14%), 43 proximal references(13%), and 42 distal references(13%). Calcium was superficial in 20(40%) and deep in 28(60%). Over the entire length of the SVGs, the maximum arc and length of calcium(in calcium-containing SVGs) averaged 174±107°and 6.8±4.8mm, respectively. In calcium-containing SVGs, lesion site arc and length of calcium measured 1.51±107°and 4.1±3.7mm, similar to the proximal and distal references(175±121°and 4.0±2.3 mm and 177±121°and 4.1±2.5mm, respectively). Graft age(7.5±4.7 versus 10.5±4.7 years, P< 0.0001), insulin-treated diabetes mellitus(40%versus 60%, P=0.02), and tobacco use(44%versus 55%, P=0.06) were clinical independent predictors of SVG calcification. Conclusions-Sixty-five percent of calcium-containing SVGs had reference calcium in the absence of lesion calcium. Calcium was located primarily in SVG wall and not at the plaque. These data suggest that SVG calcium is not just part of lesion formation and maturation. SVG calcium occurred more commonly in older grafts, in insulin-treated diabetic patients, and in smokers.展开更多
Objectives We sought to examine saphenous vein graft (SVG) lesions that fail within the first year after operation. Background Saphenous vein grafts remain patent for approximately 10 years; how ever, up to 15%to 20%o...Objectives We sought to examine saphenous vein graft (SVG) lesions that fail within the first year after operation. Background Saphenous vein grafts remain patent for approximately 10 years; how ever, up to 15%to 20%of SVGs become occluded within the first year. Methods We studied 100 patients who underwent percutaneous coronary intervention(PCI) for early (< 1 year post implantation) SVG failure lesions and compared them with a diabetes and hypercholesterolemia matched cohort of late SVG failures (>1 yea r). Coronary angiography and intravascular ultrasound images were analyzed. Resu lts The majority of patients in both groups were males who presented with unstab le angina; 36%were diabetic. Graft ages were 6.0 ±2.9 months and 105.4 ±50.8 months, respectively. The early SVG failure lesion location was more often ostia l or proximal (62%vs. 42%, respectively). Early SVG failures were angiographic ally smaller than late failures (reference: 2.47 ±0.86 mm vs. 3.26 ±0.83 mm, p < 0.001) but had similar lesion lengths. Intravascular ultrasound showed that ea rly failure lesions had smaller proximal and distal reference lumen areas (7.3± 6.8mm2 vs. 10.6±3.8mm2, p=0.026) and greater reference plaque burden than late failures (52.3%vs. 36.1%, p < 0.001). After PCI, 20.6%of early and 30.6%of l ate failure lesions had creatine kinase myocardial band(CK MB) greater than tw ice normal. Conclusions Early SVG failure is mostly proximal or ostial, lesions appear focal, and early SVGs appear smaller than late SVGs. Intravascular ultras ound shows significant reference segment plaque burden, suggesting more severe, diffuse SVG disease.展开更多
Background Intravascular ultrasound(IVUS) is increasingly used as an end poin t in studies aimed at reducing progression or inducing regression of coronary ar tery disease. However, data linking serial changes by IVUS...Background Intravascular ultrasound(IVUS) is increasingly used as an end poin t in studies aimed at reducing progression or inducing regression of coronary ar tery disease. However, data linking serial changes by IVUS with clinical outcome s are scarce. Methods and Results In the absence of a validated risk score for secondary prevention, we compared 3 established risk scores for primary preventi on PROCAM, SCORE, and Framingham with plaque progression and lumen reduction a s assessed with serial IVUS(follow up, 18±9 months) in atherosclerotic left ma in coronary arteries of 56 patients with established atherosclerosis. For all 3 algorithms, patients at highest estimated risk of events showed greater plaque p rogression than patients at lowest risk (P< 0.05 to< 0.01). There were positive linear relationships between the risk of clinical events and plaque progression (r=0.41 to 0.60; P< 0.002 to< 0.0001). This translated into a greater decrease i n lumen dimensions with increasing risk(P< 0.05, PROCAM and SCORE). Risk predict ion using the PROCAM algorithm showed the strongest relation with serial IVUS. D uring follow up, 18 patients suffered from adverse cardiovascular events; these patients had an annual plaque progression that was significantly greater than o ther patients (25.2±19.4%versus 5.9±15.6%,P<0.001). Conclusions There was a positive linear relationship between the estimated risk of clinical events deri ved from all 3 established risk score algorithms and the extent of plaque progr ession measured by serial IVUS. This translated into stenosis progression (reduc tion in lumen dimensions) with increasing clinical risk.展开更多
OBJECTIVES: We present the remodeling index(RI) versus serial intravascular ul trasound(IVUS) data. BACKGROUND: The RI, derived by comparing lesion external el astic membrane(EEM) cross-sectional area versus the refer...OBJECTIVES: We present the remodeling index(RI) versus serial intravascular ul trasound(IVUS) data. BACKGROUND: The RI, derived by comparing lesion external el astic membrane(EEM) cross-sectional area versus the reference at one time point , is used in various IVUS studies as a substitute of true remodeling(change in E EM over time), assuming that it represents true remodeling. METHODS:We studied 4 6 non-stenotic left main arteries using serial IVUS(follow-up 18±8 months). P laques were divided into subgroups according to the follow-up RI: follow-up RI >1(n=27) versus follow-up RI ≤1(n=19). RESULTS: Lesions with a follow-up RI >1 had an increase in lumen despite an increase in plaque because of an increase in EEM. Conversely, lesions with a follow-up RI ≤1 had a reduction in lumen a s a result of both a plaque increase and EEM decrease. Overall, the follow-up R I correlated directly with changes in lesion site EEM(baseline-to-follow-up). Although there was no correlation between the follow-up RI and changes in refe rence EEM area, changes in reference EEM area did correlate directly with change s in lesion EEM area. In nearly 90%of lesions with a follow-up RI >1, there wa s a previously documented increase in EEM area. Using multivariate linear regres sion analysis, the follow-up RI was dependent on the baseline RI, the increase in lesion EEM area, and the decrease in reference EEM area. The follow-up RI wa s not dependent on changes in lesion plaque area. CONCLUSIONS: The vast majority of left main lesions with a remodeling index >1 had evidence of a previous incr ease in lesion-site EEM area.展开更多
This study aimed to compare the outcomes of patients with late total occlusion(LTO) versus patients with recurrence in the absence of LTO after intracoronary radiation therapy for in-stent restenosis. LTO, especially ...This study aimed to compare the outcomes of patients with late total occlusion(LTO) versus patients with recurrence in the absence of LTO after intracoronary radiation therapy for in-stent restenosis. LTO, especially in the context of acute myocardial infarction, after intracoronary radiation therapy for in-stent restenosis, is associated with negative clinical outcomes after 6 and 12 months compared with in-stent restenosis without LTO.展开更多
文摘Background-The pattern of saphenous vein graft(SVG) calcification before percutaneous intervention has not been studied. Methods and Results-We used diagnostic and preintervention intravascular ultrasound(IVUS) to determine the incidence and magnitude of SVG calcification in 334 SVG lesions in 274 consecutive patients. Calcium was found in 133 SVGs(40%). Calcium was uniformly distributed among 48 lesion sites(14%), 43 proximal references(13%), and 42 distal references(13%). Calcium was superficial in 20(40%) and deep in 28(60%). Over the entire length of the SVGs, the maximum arc and length of calcium(in calcium-containing SVGs) averaged 174±107°and 6.8±4.8mm, respectively. In calcium-containing SVGs, lesion site arc and length of calcium measured 1.51±107°and 4.1±3.7mm, similar to the proximal and distal references(175±121°and 4.0±2.3 mm and 177±121°and 4.1±2.5mm, respectively). Graft age(7.5±4.7 versus 10.5±4.7 years, P< 0.0001), insulin-treated diabetes mellitus(40%versus 60%, P=0.02), and tobacco use(44%versus 55%, P=0.06) were clinical independent predictors of SVG calcification. Conclusions-Sixty-five percent of calcium-containing SVGs had reference calcium in the absence of lesion calcium. Calcium was located primarily in SVG wall and not at the plaque. These data suggest that SVG calcium is not just part of lesion formation and maturation. SVG calcium occurred more commonly in older grafts, in insulin-treated diabetic patients, and in smokers.
文摘Objectives We sought to examine saphenous vein graft (SVG) lesions that fail within the first year after operation. Background Saphenous vein grafts remain patent for approximately 10 years; how ever, up to 15%to 20%of SVGs become occluded within the first year. Methods We studied 100 patients who underwent percutaneous coronary intervention(PCI) for early (< 1 year post implantation) SVG failure lesions and compared them with a diabetes and hypercholesterolemia matched cohort of late SVG failures (>1 yea r). Coronary angiography and intravascular ultrasound images were analyzed. Resu lts The majority of patients in both groups were males who presented with unstab le angina; 36%were diabetic. Graft ages were 6.0 ±2.9 months and 105.4 ±50.8 months, respectively. The early SVG failure lesion location was more often ostia l or proximal (62%vs. 42%, respectively). Early SVG failures were angiographic ally smaller than late failures (reference: 2.47 ±0.86 mm vs. 3.26 ±0.83 mm, p < 0.001) but had similar lesion lengths. Intravascular ultrasound showed that ea rly failure lesions had smaller proximal and distal reference lumen areas (7.3± 6.8mm2 vs. 10.6±3.8mm2, p=0.026) and greater reference plaque burden than late failures (52.3%vs. 36.1%, p < 0.001). After PCI, 20.6%of early and 30.6%of l ate failure lesions had creatine kinase myocardial band(CK MB) greater than tw ice normal. Conclusions Early SVG failure is mostly proximal or ostial, lesions appear focal, and early SVGs appear smaller than late SVGs. Intravascular ultras ound shows significant reference segment plaque burden, suggesting more severe, diffuse SVG disease.
文摘Background Intravascular ultrasound(IVUS) is increasingly used as an end poin t in studies aimed at reducing progression or inducing regression of coronary ar tery disease. However, data linking serial changes by IVUS with clinical outcome s are scarce. Methods and Results In the absence of a validated risk score for secondary prevention, we compared 3 established risk scores for primary preventi on PROCAM, SCORE, and Framingham with plaque progression and lumen reduction a s assessed with serial IVUS(follow up, 18±9 months) in atherosclerotic left ma in coronary arteries of 56 patients with established atherosclerosis. For all 3 algorithms, patients at highest estimated risk of events showed greater plaque p rogression than patients at lowest risk (P< 0.05 to< 0.01). There were positive linear relationships between the risk of clinical events and plaque progression (r=0.41 to 0.60; P< 0.002 to< 0.0001). This translated into a greater decrease i n lumen dimensions with increasing risk(P< 0.05, PROCAM and SCORE). Risk predict ion using the PROCAM algorithm showed the strongest relation with serial IVUS. D uring follow up, 18 patients suffered from adverse cardiovascular events; these patients had an annual plaque progression that was significantly greater than o ther patients (25.2±19.4%versus 5.9±15.6%,P<0.001). Conclusions There was a positive linear relationship between the estimated risk of clinical events deri ved from all 3 established risk score algorithms and the extent of plaque progr ession measured by serial IVUS. This translated into stenosis progression (reduc tion in lumen dimensions) with increasing clinical risk.
文摘OBJECTIVES: We present the remodeling index(RI) versus serial intravascular ul trasound(IVUS) data. BACKGROUND: The RI, derived by comparing lesion external el astic membrane(EEM) cross-sectional area versus the reference at one time point , is used in various IVUS studies as a substitute of true remodeling(change in E EM over time), assuming that it represents true remodeling. METHODS:We studied 4 6 non-stenotic left main arteries using serial IVUS(follow-up 18±8 months). P laques were divided into subgroups according to the follow-up RI: follow-up RI >1(n=27) versus follow-up RI ≤1(n=19). RESULTS: Lesions with a follow-up RI >1 had an increase in lumen despite an increase in plaque because of an increase in EEM. Conversely, lesions with a follow-up RI ≤1 had a reduction in lumen a s a result of both a plaque increase and EEM decrease. Overall, the follow-up R I correlated directly with changes in lesion site EEM(baseline-to-follow-up). Although there was no correlation between the follow-up RI and changes in refe rence EEM area, changes in reference EEM area did correlate directly with change s in lesion EEM area. In nearly 90%of lesions with a follow-up RI >1, there wa s a previously documented increase in EEM area. Using multivariate linear regres sion analysis, the follow-up RI was dependent on the baseline RI, the increase in lesion EEM area, and the decrease in reference EEM area. The follow-up RI wa s not dependent on changes in lesion plaque area. CONCLUSIONS: The vast majority of left main lesions with a remodeling index >1 had evidence of a previous incr ease in lesion-site EEM area.
文摘This study aimed to compare the outcomes of patients with late total occlusion(LTO) versus patients with recurrence in the absence of LTO after intracoronary radiation therapy for in-stent restenosis. LTO, especially in the context of acute myocardial infarction, after intracoronary radiation therapy for in-stent restenosis, is associated with negative clinical outcomes after 6 and 12 months compared with in-stent restenosis without LTO.