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Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation

Serial intravascular ultrasound analysis from the sirius trial

Shinjo Sonoda, MD^*, Yoshihiro Morino, MD^*, Junya Ako, MD^*, Mitsuyasu Terashima, MD^*, Ali H. M. Hassan, MD^*, Heidi N. Bonneau, RN, MS, Martin B. Leon, MD, FACC, Jeffrey W. Moses, MD, FACC, Paul G. Yock, MD, FACC^*, Yasuhiro Honda, MD^*, Richard E. Kuntz, MD, MSc, Peter J. Fitzgerald, MD, PhD, FACC^*,* for the SIRIUS Investigators

^* Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, California, USA
Highlands Consulting Inc., San Jose, California, USA
Lenox Hill Hospital, New York, New York, USA
Brigham and Women's Hospital, Boston, Massachusetts, USA

View larger version (17K): [in a new window]   Figure 1 Distribution of percentage of neointimal area (%NA, neointimal area/stent area) at the site of follow-up minimum lumen area for sirolimus-eluting stents (SES) (left) and bare metal stents (BMS) (right).

View larger version (22K): [in a new window]   Figure 2 Relationship between postprocedural minimum stent area (MSA) and follow-up minimum lumen area (MLA). Sirolimus-eluting stents (SES) showed higher correlation than bare metal stents (BMS) (0.80 vs. 0.65) with a higher regression coefficient (0.92 vs. 0.59), indicating consistent efficacy of SES, irrespective of variable degrees of biological activity in each individual lesion.

View larger version (19K): [in a new window]   Figure 3 The sensitivity and specificity curves identified different optimal thresholds of minimum stent area (MSA) to predict adequate follow-up minimum lumen area (MLA): 5.0 mm2 for sirolimus-eluting stents (SES) and 6.5 mm2 for bare metal stents (BMS). Sirolimus-eluting stents may achieve better longer-term outcome with an "optimized" lower MSA threshold. Triangles = sensitivity; circles = specificity.

View larger version (19K): [in a new window]   Figure 4 The receiver operating characteristic (ROC) curves showed comparison of the diagnostic value between absolute minimum stent area (MSA) and relative parameter to the reference artery (MSA/reference vessel area [REFVA]). These curves interpreted that absolute MSA was a more simple and stronger predictive parameter than MSA/REFVA. BMS = bare metal stents; SES = sirolimus-eluting stents.