Prognostic value of the modified American College of Cardiology/American Heart Association stenosis morphology classification for long-term angiographic and clinical outcome after coronary stent placement

Background-The modified American College of Cardiology/American Heart Assoc iation (ACC/AHA) lesion morphology criteria are predictive of early outcome after various coronary catheter interventions. Their potential prognostic value after stent implantation and, in particular, for restenosis and long- term clinical outcome has not been studied. We assessed the prognostic valu e of the modified ACC/AHA criteria for the long-term angiographic and clini cal outcome of patients after coronary stenting. Methods and Results-This study includes 2944 consecutive patients with symp tomatic coronary artery disease treated with coronary stent placement. Modi fied ACC/AHA lesion morphology criteria were used to qualitatively assess t he angiograms; type A and B1 lesions were categorized as simple, and type B 2 and C lesions were designated complex. Primary end points were angiograph ic restenosis and 1-year event-free survival. Restenosis rate was 33.2% in complex lesions and 24.9% in simple lesions (P<0.001). it was 21.7% for typ e A, 26.3% for type B1, 33.7% for type B2, and 32.6% for type C lesions. On e-year event-free survival was 75.6% for patients with complex lesions and 81.1% for patients with simple lesions (P<0.001), It was 85.2% for patients with type A, 79.4% for type B1, 75.9% for type B2, and 75.2% type C lesion s. The higher risk for restenosis and an adverse outcome associated with co mplex lesions was also maintained after multivariate adjustment for other c linical and angiographic characteristics. Conclusions The modified ACC/AHA lesion morphology scheme has significant p rognostic value for the outcome of patients after coronary stent placement. Lesion morphology is able to influence the restenosis process and thus the entire 1-year clinical course of these patients.