Background. Treatment of coronary intermediate lesions remains a controversy, and the role of arterial remodeling patterns determined by intravascular ultrasound in intermediate lesion is still not well known. The aim of this study was to investigate the impact of arterial remodeling of intermediate coronary lesions on long-term clinical outcomes. Methods. Arterial remodeling patterns were assessed in 212 deferred intermediate lesions from 162 patients after IVUS examination. Negative, intermediate, and positive remodeling was defined as a remodeling index of <0.88, 0.88∼1.0, and >1.0, respectively. The primary endpoint was the composite vessel-oriented clinical events, defined as the composition of target vessel-related cardiac death, target vessel-related myocardial infarction, and target vessel revascularization. Quantitative flow ratio was assessed for evaluating the functional significance of intermediate lesions. Results. 72 intermediate remodeling lesions were present in 66 patients, whereas 77 negative remodeling lesions were present in 71 patients, and 63 positive remodeling lesions were present in 55 patients. Negative remodeling lesions had the smallest minimum lumen area (4.16 ± 1.03 mm² vs. 5.05 ± 1.39 mm² vs. 4.85 ± 1.76 mm²; ), smallest plaque burden (63.45 ± 6.13% vs. 66.12 ± 6.82% vs. 71.17 ± 6.45%; ), and highest area stenosis rate (59.32% ± 10.15% vs. 54.61% ± 9.09% vs. 51.67% ± 12.96%; ). No significant difference was found in terms of quantitative flow ratio among three groups. At 5 years follow-up, negative remodeling lesions had a higher rate of composite vessel-oriented clinical event (14.3%), compared to intermediate (1.4%, ) or positive remodeling lesions (4.8%, ). After adjusting for multiple covariates, negative remodeling remained an independent determinant for vessel-oriented clinical event (HR: 4.849, 95% CI 1.542–15.251, ). Conclusion. IVUS-derived negative remodeling is associated with adverse long-term clinical outcome in stable patients with intermediate coronary artery stenosis.

中文翻译：

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中间冠状动脉病变的动脉重塑对稳定型冠状动脉疾病患者长期临床结局的影响：一项血管内超声研究

背景。冠状动脉中间病变的治疗仍然存在争议，血管内超声确定的动脉重构模式在中间病变中的作用仍不清楚。本研究的目的是调查中间冠状动脉病变的动脉重塑对长期临床结果的影响。方法. 在 IVUS 检查后，评估了来自 162 名患者的 212 个延迟中间病变的动脉重塑模式。负、中、正重塑定义为重塑指数分别<0.88、0.88∼1.0和>1.0。主要终点是复合血管导向的临床事件，定义为靶血管相关心源性死亡、靶血管相关心肌梗死和靶血管血运重建的组成。评估定量流量比以评估中间病变的功能意义。结果. 66 例患者存在 72 个中间重塑病灶，71 例患者出现 77 个阴性重塑病灶，55 例患者出现 63 个阳性重塑病灶。阴性重塑病变具有最小的最小管腔面积（4.16 ± 1.03 mm ²对 5.05 ± 1.39 mm ²对 4.85 ± 1.76 mm ²；),最小斑块负担 (63.45 ± 6.13% vs. 66.12 ± 6.82% vs. 71.17 ± 6.45%;)，以及最高区域狭窄率 (59.32% ± 10.15% vs. 54.61% ± 9.09% vs. 51.67% ± 12.96%;）。三组间定量流量比无显着差异。在 5 年的随访中，与中间病变（1.4%，)或阳性重塑病变 (4.8%,）。在调整多个协变量后，负重构仍然是血管导向临床事件的独立决定因素（HR：4.849，95% CI 1.542–15.251，）。 结论。IVUS 衍生的负性重构与冠状动脉中间狭窄的稳定患者的不良长期临床结果相关。