1018-47 A Matched Comparison of the Longterm Outcome of Directional Coronary Atherectomy versus Coronary Stenting

To compare the renarrowing process after atherectomy (DCA) and stenting, we reviewed the cineangiograms from a prospectively collected series of 234 matched DCA and stent patients (pts) with identical baseline clinical and angiographic characteristics. In addition, we explored whether the process of luminal renarrowing was related to the extent or mechanism of luminal improvement in matched pts with comparable lesion location, vessel size (RD), lesion severity (MLD) and acute gain. Multivariate analyses were performed to determine the correlates of minimal lumen at follow-up and lumen loss. Matching was considered adequate since lesion distribution, RD (3.09 vs 3.09mm) and MLD (1.12 vs 1.12 mm) were equal in both groups. Stenting lesulted in a larger increase in MLD than DCA (1.41 vs 1.20mm; p=0.0002), similar late loss (0.57 vs 0.66mm; p=NS) with subsequently a larger MLD at follow-up (1.96 vs 1.66mm; p=0.0001). However, when additional matching (n=150 pts) for acute gain (1.34 vs 1.33mm) was performed, late lumen loss was significantly smaller after stenting (0.52 vs 0.75mm; p=0.007) leading to a favorable long-term MLD (1.90 vs 1.66mm; p=0.004) when compared with DCA. Multivariate analysis revealed device type, vessel size and lumen gain as independent predictors for MLD at follow-up. The changes in MLD are shown in cumulative distribution curves: Multivariate analysis of MLD at follow-up Intercept Coefficient p-value -0.63 RD 0.19 0.12 MLD pre 0.76 0.004 Gain 0.67 0.0001 Device -24* 0.003 DCA=1. STENT=0 In conclusion the long-term angiographic outcome of stenting seems more favorable than of directional atherectomy due to a larger acute luminal gain and a substantial reduction in late luminal loss. It appears that the late outcome after an intervention is not only related to extent of luminal improvement but also to the mechanism of acute gain (device type).