Author + information
- Aymen Noamen,
- Nadhem Hajlaoui,
- Dhaker Laahideb,
- Mehdi Ghommid,
- Khalil Houissa,
- Wafa Fehri and
- Habib Haouala
Quantitative coronary angiography-maximal lumen diameter (Dmax) guided scaffold size selection has been proposed to optimize the scaffold implantation procedure. This study sought to investigate the clinical outcomes based on the assessment of QCA-Dmax.
A total of 29 patients received scaffolds in the military hospital of Tunis registry. The incidence of major adverse cardiac events (MACE) (a composite of cardiac death, any myocardial infarction [MI], and target lesion revascularization [TLR]) was analyzed according to the Dmax sub classification of scaffold.
Pre-procedural Dmax was assessed in all cases. In four (13,8%) patients, the ratio of pre procedural Dmax to device diameter values were under 0,9 (undersized group 13,8%) whereas in 20 (69%) of patients, this ratio was between 0,9 and 1,1. The rate of MACE at 18 month was higher in the undersized and oversized groups than in the well sized group respectively 100% , 50% and 35% (Log Rank p=0,02) mainly driven by a higher TLR rate respectively 100%, 40% and 31,6% (Log Rank p<0,001) . The independent MACE determinants were both absence of IVUS guided procedure (hazard ratio [HR]: 2.72, 95% confidence interval [CI]: 0, 6 to 12,2 ; p = 0,193) and the lack of post dilatation (HR: 2.6, 95% CI: 0, 8 to 7,7 ; p = 0,086).
Inappropriate sizing of scaffold appears to be associated with a higher 18 month MACE rate driven by more frequent TLR. The current results should be confirmed in large-scale randomized trials.