SYNTAX Score and Pre- and Poststent Optical Coherence Tomography Findings in the Left Anterior Descending Coronary Artery in Patients With Stable Angina Pectoris

https://doi.org/10.1016/j.amjcard.2017.06.017Get rights and content

SYNTAX score (SS) has been reported to be an independent predictor of future cardiac events including target lesion revascularization. The aim of this study was to assess the relation between SS and plaque characteristics and poststent vascular response using optical coherence tomography in coronary artery tree and left anterior descending artery (LAD) in patients with stable angina. A total of 179 lesions among 165 patients, including 100 lesions in LAD, were analyzed. Patients were stratified into tertiles. In pre–percutaneous coronary intervention analysis of whole coronary tree and LAD, lesions of the third tertile had the highest prevalence of lipid-rich plaque. Compared with the first tertile, the third tertile had greater lipid index, thinner fibrous cap, and higher prevalence of thin-cap fibroatheroma. In poststent optical coherence tomography, the incidence of stent edge dissection and irregular protrusion was higher in the third tertile compared with the first tertile in coronary tree analysis. In LAD analysis, the prevalence of irregular protrusion was the highest in the third tertile. In conclusion, high SS may reflect higher plaque vulnerability. Stent edge dissection and irregular protrusion were more frequent in patients with higher SS, indicating poor vascular response to stenting. Our results may explain higher cardiac event rate and target lesion revascularization in patients with higher SS.

Section snippets

Methods

Subjects were selected from the Massachusetts General Hospital (MGH) OCT Registry. The MGH OCT Registry is an ongoing international multicenter registry of patients who have undergone OCT of the coronary arteries at 20 sites across 6 countries (http://www.clinicaltrials.gov: NCT01110538). For the purpose of this study, we included patients presenting with stable angina who have undergone percutaneous coronary intervention (PCI; n = 247). Patients who had both optimal angiography and OCT images

Results

In the 3vessel-SS analysis, SS tertiles were defined as follows: first tertile from 2 to 6.5 points, second tertile from 7 to 11.5 points, and third tertile from 12.0 to 26.0 points. A total of 165 patients (179 lesions) were included in the analysis: 48 patients (52 lesions) in the first tertile, 59 patients (65 lesions) in the second tertile, and 58 patients (62 lesions) in the third tertile. Baseline characteristics are shown in Table 1. In 179 lesions, 100 lesions were in the LAD, 52 in the

Discussion

To our knowledge, this study is the first report investigating local plaque characteristics in relation to the degree of atherosclerosis (measured by SS) in the whole coronary tree, and plaque characteristics in relation to the lesion complexity in patients with stable angina. The main findings of this study were as follows: (1) more progressed coronary artery disease (CAD) and higher lesion complexity measured by SS is associated with higher prevalence of lipid-rich plaque and features of

Disclosures

Ik-Kyung Jang has received fellowship grant and consulting fees from Abbott.

Acknowledgment

The authors thank all the investigators and all supporting staff. Dr. Jang's research was supported by “Michael and Kathryn Park”, and by “Gill and Allan Gray.” Dr. Thomas Zanchin is supported by the Swiss National Science Foundation grant number 323530_171146. Dr. Tomoyo Sugiyama is supported in part by the grant from Strategic International Research Collaboration Program with Harvard Medical School to Cultivate Professionals with Knowledge and Humanity from Japan Society for the Promotion of

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