Risk of target lesion failure in relationship to vessel angiographic geometry and stent conformability using the second generation of drug-eluting stents
Background: Vessel angulation and large changes in vessel geometry after stent implantation have been associated with an increased risk of target lesion failure (TLF) using bare-metal stents. Second-generation drug-eluting stents (DES)offer superior conformability and inhibition of neointima. The aim of the study is to investigate the relationship between pre and post-implant vessel geometry and the occurrence of TLF at 1 year after treatment with second-generation DES; and to compare the conformability of Resolute and Xience stents. Methods: The RESOLUTE All-Comers trial randomized 2292 patients (3366 lesions) to Resolute zotarolimus-DES (Medtronic CardioVascular) or Xience everolimus-DES (Abbott Vascular). At 1 year, 176 lesions (121 patients)presented with TLF; a composite of cardiac death, acute myocardial infarction (AMI) and target lesion revascularization (TLR). Lesions with TLF were matched with 176 lesions (168 patients) without TLF adjusting for clinical and procedural characteristics. The number of bends, vessel curvature and angulation were assessed with quantitative coronary angiography pre and post-implantation. The absolute difference post minus pre-implantation was used as a surrogate of stent conformability. Results: At pre-implantation, lesions without and with TLF had similar numbers of bends/lesion (1.81 vs 1.74; P =.35), vessel curvature (0.295 cm-1vs 0.363 cm-1; P =.13) and vessel angulation (46.3° vs 43.5°; P =.80), respectively. Lesions without and with TLR also had similar numbers of bends/lesion (1.39 vs 1.39; P =.83), vessel curvature (0.368 cm-1vs 0.325 cm-1; P =.33) and angulation (40.2° vs 37.2°; P =.19). Lesions without and with in-hospital AMI also presented with similar number of bends/lesion (1.69 vs 1.81; P =.48), vessel curvature (0.349 cm-1vs 0.345 cm-1; P =.91) and vessel angulation (43.53° vs 48.45°; P =.38). The absolute difference post- - pre-implantation was similar in lesions without and with TLF, TLR and In-hospital AMI. The absolute difference post- - pre-implantation was similar with both Resolute and Xience in vessel curvature (-0.046 cm-1vs -0.047 cm-1; P =.66) and was smaller in number of bends/lesion (-0.08 vs -0.16; P =.13) and in vessel angulation (-6.0° vs -10.1°; P =.03) with the Resolute. Conclusions: Bended, curved, and angulated lesions and changes in the number of bends/lesion, vessel curvature, and angulation from pre to post-implantation have no relation with TLF and TLR at 1 year and have no relation with In-hospital AMI using second-generation of DES. Resolute appears to be more conformable than Xience.