COMPARISON OF ANGIOSCOPY, INTRAVASCULAR ULTRASOUND IMAGING AND QUANTITATIVE CORONARY ANGIOGRAPHY IN PREDICTING CLINICAL OUTCOME AFTER CORONARY INTERVENTION IN HIGH-RISK PATIENTS

Objectives. The purpose df this study was to identify qualitative or q uantitative variables present on angioscopy, intravascular ultrasound imaging or quantitative coronary arteriography that were associated wi th adverse clinical outcome after coronary intervention in high risk p atients. Background. Patients with acute coronary syndromes and comple x lesion morphology on angiography are at increased risk for acute com plications after coronary angioplasty. Newer devices that primarily re move atheroma have not improved outcome over that of balloon angioplas ty. Intravascular imaging can accurately identify intraluminal and int ramural histopathologic features not adequately visualized during coro nary arteriography and may provide mechanistic insight into the pathog enesis of abrupt closure and restenosis. Methods. Sixty high risk pati ents with unstable coronary syndromes and complex lesions on angiograp hy underwent angioscopy (n = 40) and intravascular ultrasound imaging (n = 46) during interventional procedures. In 26 patients, both angios copy and intravascular ultrasound were performed in the same lesion. A ll patients underwent off-line quantitative coronary arteriography. Co ronary interventions included balloon (n = 21) and excimer laser (n = 4) angioplasty, directional (n = 19) and rotational (n = 6) atherectom y and stent implantation (n = 11). Patients were followed up for 1 yea r for objective evidence of recurrent ischemia. Results. Patients whos e clinical presentation included rest angina or acute myocardial infar ction or who received thrombolytic therapy within 24 h of procedure we re significantly more likely to experience recurrent ischemia after in tervention. Plaque rupture or thrombus on preprocedure angioscopy or a ngioscopic thrombus after intervention were also significantly associa ted with adverse outcome. Qualitative or quantitative variables on ang iography, intravascular ultrasound or off-line quantitative arteriogra phy were not associated with recurrent ischemia on univariate analysis . Multivariate predictors of recurrent ischemia were plaque rupture on preprocedure angioscopy (p < 0.05, odds ratio [OR] 10.15) and angiosc opic thrombus after intervention (p < 0.05, OR 7.26). Conclusions. Ang ioscopic plaque rupture and thrombus were independently associated wit h adverse outcome in patients with complex lesions after interventiona l procedures. These features were not identified by either angiography or intravascular ultrasound.