Clinical impact of the gap-angle ratio in patients with ostial lesions of the right coronary artery undergoing percutaneous coronary intervention
The aim of this study was to investigate the incidence of binary restenosis and its predictors in patients with ostial lesions of the right coronary artery (RCAos) who underwent percutaneous coronary intervention (PCI). RCAos are associated with a high incidence of restenosis, and the implantations...
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| Veröffentlicht in: | Heart and vessels 2019-11, Vol.34 (11), p.1717-1727 |
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| creator | Ohashi, Koichi Abe, Daisuke Kuroki, Norihiro Yuba, Takao Suzuki, Kou |
| description | The aim of this study was to investigate the incidence of binary restenosis and its predictors in patients with ostial lesions of the right coronary artery (RCAos) who underwent percutaneous coronary intervention (PCI). RCAos are associated with a high incidence of restenosis, and the implantations of drug-eluting stents for RCAos have not been fully elucidated. The study participants included 75 patients (72.3 ± 9.5 years, 72% men) who underwent PCI for RCAos at our institution between November 2001 and May 2017. The angle between the greater curvature of the aortic wall and the right coronary artery take-off in the diastolic and systolic phases in the left anterior oblique position view was investigated. Clinical outcome was defined as binary restenosis at follow-up coronary angiography. We also evaluated target lesion failure (TLF) defined as a composite of cardiac mortality, target vessel myocardial infarction, and target lesion revascularization (TLR). The incidence of binary restenosis was 48.0% (
n
= 36) of the entire cohort. The incidence of TLF was 49.3% (
n
= 37) of the entire cohort, which was mainly driven by TLR (36.0%,
n
= 27). The area under the curve of the gap-angle ratio [(difference between the maximum and minimum angles)/(minimum angle); GAR] for binary restenosis was 0.73, and the cutoff value was 0.306 (sensitivity 67%, specificity 82%). The patients were divided into two groups: a low-GAR ( 0.306;
n
= 45). Binary restenosis was more frequent in the high-GAR group than in the low-GAR group (76.7% vs. 28.9%,
p
= 0.007). The cumulative rate of TLF was significantly higher in the high-GAR group when compared with the low-GAR group (53.3% vs. 40.0%,
p
= 0.01), which was mainly driven by TLR (56.7% vs. 22.2%,
p
= 0.01). High-GAR (> 0.306) [OR 2.66 (1.34–5.31),
p
= 0.005] and stent under expansion [OR 2.37 (1.10–5.11),
p
= 0.03] were found to be independent predictors of binary restenosis after adjustment for multiple confounders. Multivariable analysis also revealed that high-GAR (> 0.306) [OR 2.06 (1.02–4.14),
p
= 0.03] and stent under expansion [OR 2.82 (1.28–6.19),
p
= 0.01] were independent predictors of TLF. We suggest that GAR (> 0.306) predicts binary restenosis and TLF in patients undergoing PCI for RCAos. |
| doi_str_mv | 10.1007/s00380-019-01417-x |
| format | Article |
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n
= 36) of the entire cohort. The incidence of TLF was 49.3% (
n
= 37) of the entire cohort, which was mainly driven by TLR (36.0%,
n
= 27). The area under the curve of the gap-angle ratio [(difference between the maximum and minimum angles)/(minimum angle); GAR] for binary restenosis was 0.73, and the cutoff value was 0.306 (sensitivity 67%, specificity 82%). The patients were divided into two groups: a low-GAR (< 0.306;
n
= 30) and high-GAR group (> 0.306;
n
= 45). Binary restenosis was more frequent in the high-GAR group than in the low-GAR group (76.7% vs. 28.9%,
p
= 0.007). The cumulative rate of TLF was significantly higher in the high-GAR group when compared with the low-GAR group (53.3% vs. 40.0%,
p
= 0.01), which was mainly driven by TLR (56.7% vs. 22.2%,
p
= 0.01). High-GAR (> 0.306) [OR 2.66 (1.34–5.31),
p
= 0.005] and stent under expansion [OR 2.37 (1.10–5.11),
p
= 0.03] were found to be independent predictors of binary restenosis after adjustment for multiple confounders. Multivariable analysis also revealed that high-GAR (> 0.306) [OR 2.06 (1.02–4.14),
p
= 0.03] and stent under expansion [OR 2.82 (1.28–6.19),
p
= 0.01] were independent predictors of TLF. We suggest that GAR (> 0.306) predicts binary restenosis and TLF in patients undergoing PCI for RCAos.</description><identifier>ISSN: 0910-8327</identifier><identifier>EISSN: 1615-2573</identifier><identifier>DOI: 10.1007/s00380-019-01417-x</identifier><identifier>PMID: 31028408</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Aged ; Angiography ; Angioplasty ; Aorta ; Biomedical Engineering and Bioengineering ; Blood vessels ; Cardiac Surgery ; Cardiology ; Coronary Angiography ; Coronary artery ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - surgery ; Coronary vessels ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - surgery ; Drug delivery ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents - pharmacology ; Implants ; Incidence ; Intervention ; Japan - epidemiology ; Lesions ; Male ; Medicine ; Medicine & Public Health ; Myocardial infarction ; Original Article ; Percutaneous Coronary Intervention - methods ; Postoperative Complications - epidemiology ; Prosthesis Design ; Registries ; Restenosis ; Risk Factors ; Sirolimus - pharmacology ; Stents ; Surgical implants ; Time Factors ; Treatment Outcome ; Vascular Surgery ; Veins & arteries</subject><ispartof>Heart and vessels, 2019-11, Vol.34 (11), p.1717-1727</ispartof><rights>Springer Japan KK, part of Springer Nature 2019</rights><rights>Springer Japan KK, part of Springer Nature 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c350t-36b98a472b2da9be233258098d86b971cb4badcece607cefcba60371110e25573</cites><orcidid>0000-0002-6971-324X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00380-019-01417-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00380-019-01417-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31028408$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ohashi, Koichi</creatorcontrib><creatorcontrib>Abe, Daisuke</creatorcontrib><creatorcontrib>Kuroki, Norihiro</creatorcontrib><creatorcontrib>Yuba, Takao</creatorcontrib><creatorcontrib>Suzuki, Kou</creatorcontrib><title>Clinical impact of the gap-angle ratio in patients with ostial lesions of the right coronary artery undergoing percutaneous coronary intervention</title><title>Heart and vessels</title><addtitle>Heart Vessels</addtitle><addtitle>Heart Vessels</addtitle><description>The aim of this study was to investigate the incidence of binary restenosis and its predictors in patients with ostial lesions of the right coronary artery (RCAos) who underwent percutaneous coronary intervention (PCI). RCAos are associated with a high incidence of restenosis, and the implantations of drug-eluting stents for RCAos have not been fully elucidated. The study participants included 75 patients (72.3 ± 9.5 years, 72% men) who underwent PCI for RCAos at our institution between November 2001 and May 2017. The angle between the greater curvature of the aortic wall and the right coronary artery take-off in the diastolic and systolic phases in the left anterior oblique position view was investigated. Clinical outcome was defined as binary restenosis at follow-up coronary angiography. We also evaluated target lesion failure (TLF) defined as a composite of cardiac mortality, target vessel myocardial infarction, and target lesion revascularization (TLR). The incidence of binary restenosis was 48.0% (
n
= 36) of the entire cohort. The incidence of TLF was 49.3% (
n
= 37) of the entire cohort, which was mainly driven by TLR (36.0%,
n
= 27). The area under the curve of the gap-angle ratio [(difference between the maximum and minimum angles)/(minimum angle); GAR] for binary restenosis was 0.73, and the cutoff value was 0.306 (sensitivity 67%, specificity 82%). The patients were divided into two groups: a low-GAR (< 0.306;
n
= 30) and high-GAR group (> 0.306;
n
= 45). Binary restenosis was more frequent in the high-GAR group than in the low-GAR group (76.7% vs. 28.9%,
p
= 0.007). The cumulative rate of TLF was significantly higher in the high-GAR group when compared with the low-GAR group (53.3% vs. 40.0%,
p
= 0.01), which was mainly driven by TLR (56.7% vs. 22.2%,
p
= 0.01). High-GAR (> 0.306) [OR 2.66 (1.34–5.31),
p
= 0.005] and stent under expansion [OR 2.37 (1.10–5.11),
p
= 0.03] were found to be independent predictors of binary restenosis after adjustment for multiple confounders. Multivariable analysis also revealed that high-GAR (> 0.306) [OR 2.06 (1.02–4.14),
p
= 0.03] and stent under expansion [OR 2.82 (1.28–6.19),
p
= 0.01] were independent predictors of TLF. We suggest that GAR (> 0.306) predicts binary restenosis and TLF in patients undergoing PCI for RCAos.</description><subject>Aged</subject><subject>Angiography</subject><subject>Angioplasty</subject><subject>Aorta</subject><subject>Biomedical Engineering and Bioengineering</subject><subject>Blood vessels</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Coronary Angiography</subject><subject>Coronary artery</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary vessels</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - surgery</subject><subject>Drug delivery</subject><subject>Drug-Eluting Stents</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Immunosuppressive Agents - pharmacology</subject><subject>Implants</subject><subject>Incidence</subject><subject>Intervention</subject><subject>Japan - epidemiology</subject><subject>Lesions</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Myocardial infarction</subject><subject>Original Article</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prosthesis Design</subject><subject>Registries</subject><subject>Restenosis</subject><subject>Risk Factors</subject><subject>Sirolimus - pharmacology</subject><subject>Stents</subject><subject>Surgical implants</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><subject>Veins & arteries</subject><issn>0910-8327</issn><issn>1615-2573</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhq0K1G4LL9BDZYlLL4GxncTOsVq1FKkSFzhbjjObdZW1U9uB8hi8MYa0VOLAwRpL8_3_jP0Tcs7gPQOQHxKAUFAB68qpmawej8iGtaypeCPFK7KBjkGlBJcn5DSlewDWdKw7JieCAVc1qA35uZ2cd9ZM1B1mYzMNO5r3SEczV8aPE9JosgvUeTqXC_qc6HeX9zSk7IpqwuSCT8-y6MZ9pjbE4E38QU3MWMriB4xjcH6kM0a7ZOMxLOmFc75w34p58XpDXu_MlPDtUz0jX2-uv2xvq7vPHz9tr-4qKxrIlWj7Tpla8p4PpuuRC8EbBZ0aVOlIZvu6N4NFiy1IizvbmxaEZIwB8qb8zxm5XH3nGB4WTFkfXLI4TetymnPWciWBQ0Hf_YPehyX6sp3mAhpV1yDqQvGVsjGkFHGn5-gO5Xmagf4dmF4D0yUw_Scw_VhEF0_WS3_A4a_kOaECiBVIpeVHjC-z_2P7C018pGQ</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Ohashi, Koichi</creator><creator>Abe, Daisuke</creator><creator>Kuroki, Norihiro</creator><creator>Yuba, Takao</creator><creator>Suzuki, Kou</creator><general>Springer Japan</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6971-324X</orcidid></search><sort><creationdate>20191101</creationdate><title>Clinical impact of the gap-angle ratio in patients with ostial lesions of the right coronary artery undergoing percutaneous coronary intervention</title><author>Ohashi, Koichi ; Abe, Daisuke ; Kuroki, Norihiro ; Yuba, Takao ; Suzuki, Kou</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c350t-36b98a472b2da9be233258098d86b971cb4badcece607cefcba60371110e25573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Angiography</topic><topic>Angioplasty</topic><topic>Aorta</topic><topic>Biomedical Engineering and Bioengineering</topic><topic>Blood vessels</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Coronary Angiography</topic><topic>Coronary artery</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary vessels</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - surgery</topic><topic>Drug delivery</topic><topic>Drug-Eluting Stents</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Immunosuppressive Agents - pharmacology</topic><topic>Implants</topic><topic>Incidence</topic><topic>Intervention</topic><topic>Japan - epidemiology</topic><topic>Lesions</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Myocardial infarction</topic><topic>Original Article</topic><topic>Percutaneous Coronary Intervention - methods</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prosthesis Design</topic><topic>Registries</topic><topic>Restenosis</topic><topic>Risk Factors</topic><topic>Sirolimus - pharmacology</topic><topic>Stents</topic><topic>Surgical implants</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ohashi, Koichi</creatorcontrib><creatorcontrib>Abe, Daisuke</creatorcontrib><creatorcontrib>Kuroki, Norihiro</creatorcontrib><creatorcontrib>Yuba, Takao</creatorcontrib><creatorcontrib>Suzuki, Kou</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Heart and vessels</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ohashi, Koichi</au><au>Abe, Daisuke</au><au>Kuroki, Norihiro</au><au>Yuba, Takao</au><au>Suzuki, Kou</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical impact of the gap-angle ratio in patients with ostial lesions of the right coronary artery undergoing percutaneous coronary intervention</atitle><jtitle>Heart and vessels</jtitle><stitle>Heart Vessels</stitle><addtitle>Heart Vessels</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>34</volume><issue>11</issue><spage>1717</spage><epage>1727</epage><pages>1717-1727</pages><issn>0910-8327</issn><eissn>1615-2573</eissn><abstract>The aim of this study was to investigate the incidence of binary restenosis and its predictors in patients with ostial lesions of the right coronary artery (RCAos) who underwent percutaneous coronary intervention (PCI). RCAos are associated with a high incidence of restenosis, and the implantations of drug-eluting stents for RCAos have not been fully elucidated. The study participants included 75 patients (72.3 ± 9.5 years, 72% men) who underwent PCI for RCAos at our institution between November 2001 and May 2017. The angle between the greater curvature of the aortic wall and the right coronary artery take-off in the diastolic and systolic phases in the left anterior oblique position view was investigated. Clinical outcome was defined as binary restenosis at follow-up coronary angiography. We also evaluated target lesion failure (TLF) defined as a composite of cardiac mortality, target vessel myocardial infarction, and target lesion revascularization (TLR). The incidence of binary restenosis was 48.0% (
n
= 36) of the entire cohort. The incidence of TLF was 49.3% (
n
= 37) of the entire cohort, which was mainly driven by TLR (36.0%,
n
= 27). The area under the curve of the gap-angle ratio [(difference between the maximum and minimum angles)/(minimum angle); GAR] for binary restenosis was 0.73, and the cutoff value was 0.306 (sensitivity 67%, specificity 82%). The patients were divided into two groups: a low-GAR (< 0.306;
n
= 30) and high-GAR group (> 0.306;
n
= 45). Binary restenosis was more frequent in the high-GAR group than in the low-GAR group (76.7% vs. 28.9%,
p
= 0.007). The cumulative rate of TLF was significantly higher in the high-GAR group when compared with the low-GAR group (53.3% vs. 40.0%,
p
= 0.01), which was mainly driven by TLR (56.7% vs. 22.2%,
p
= 0.01). High-GAR (> 0.306) [OR 2.66 (1.34–5.31),
p
= 0.005] and stent under expansion [OR 2.37 (1.10–5.11),
p
= 0.03] were found to be independent predictors of binary restenosis after adjustment for multiple confounders. Multivariable analysis also revealed that high-GAR (> 0.306) [OR 2.06 (1.02–4.14),
p
= 0.03] and stent under expansion [OR 2.82 (1.28–6.19),
p
= 0.01] were independent predictors of TLF. We suggest that GAR (> 0.306) predicts binary restenosis and TLF in patients undergoing PCI for RCAos.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>31028408</pmid><doi>10.1007/s00380-019-01417-x</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-6971-324X</orcidid></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Angiography Angioplasty Aorta Biomedical Engineering and Bioengineering Blood vessels Cardiac Surgery Cardiology Coronary Angiography Coronary artery Coronary Artery Disease - diagnosis Coronary Artery Disease - surgery Coronary vessels Coronary Vessels - diagnostic imaging Coronary Vessels - surgery Drug delivery Drug-Eluting Stents Female Follow-Up Studies Humans Immunosuppressive Agents - pharmacology Implants Incidence Intervention Japan - epidemiology Lesions Male Medicine Medicine & Public Health Myocardial infarction Original Article Percutaneous Coronary Intervention - methods Postoperative Complications - epidemiology Prosthesis Design Registries Restenosis Risk Factors Sirolimus - pharmacology Stents Surgical implants Time Factors Treatment Outcome Vascular Surgery Veins & arteries |
| title | Clinical impact of the gap-angle ratio in patients with ostial lesions of the right coronary artery undergoing percutaneous coronary intervention |
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