The relative influence of lesion length and other stenosis morphologies onprocedural success of coronary intervention

As coronary interventional technology improves, the influence of lesion len gth (LL) on procedural success and device selection may-vary. Thus, the aut hors prospectively analyzed 957 consecutive coronary interventions (CI) in 1,404 stenoses to ascertain the influence of lesion length on CI outcome. S tenosis morphology was prospectively classified by the AHA/ACC criteria. LL was analyzed both as dichotomous (S: < 10 mm, L: > 10 mm) variables and by the three-tiered AHA/ACC criteria (I: < 10 mm, II: 10-20 mm, III: > 20 mm) . There was a significant univariate relationship between CI success and S stenosis (S: 95.8% vs L: 91.8%, p = 0.002 and I: 96.0%, II: 91.7%, III: 89. 3%). Numerous interrelationships involving the morphologic characteristics were noted: lesion morphologies associated with S lesions were concentric ( P = 0.0001) and had smooth contour (p = 0.0001), ostial location (p = 0.05) and little calcification (p = 0.0007), while irregular contour (p = 0.0001 ), calcification (p = 0.0076), eccentric (p = 0.0001), thrombus (p = 0.0001 ), recent (p = 0.0001) or chronic (p = 0.001) total occlusion were associat ed with L lesions. When these relationships were taken into account by mult iple logistic regression analysis, lesion length was not predictive of proc edural outcome (p = 0.099). One morphologic type was associated with increa sed CI success: irregular contour (p = 0.022); recent (p < 0.0001) or chron ic (< 0.0001) occlusions were associated with decreased CI success. Another factor considered was device selection: S lesions were associated with gre ater balloon angioplasty usage (p = 0.002), whereas more coronary stents (p = 0.024) and rotoblator (p = 0.018) devices were used in L lesions. More b alloon angioplasty was performed in concentric (p < 0.0001) lesions; interv entional devices were employed more often in eccentric (p < 0.0001) and irr egular lesions (p < 0.0001). More complications were noted in lesions with thrombus (p = 0.0002), but lesion length was not predictive (p = NS). Lesio n length is not a significant predictor of procedural success when adjusted for other lesion morphologies in the modern interventional era. The availa bility of new devices has improved the results in longer lesions since the AHA/ACC criteria were originally proposed.