Imaging Characteristics of Mismatch Lesions: An Angiographic and Intravascular Ultrasound Analysis of 1369 Coronary Lesions

Abstract

Objectives:To evaluate the angiographic and intravascular ultrasound (IVUS) characteristics of coronary mismatch lesions.Background:Better understanding about the characteristics of mismatch lesions may help to achieve more accurate lesion assessment and, thereby, to improve the outcomes of percutaneous coronary intervention (PCI).Methods:Angiographic and IVUS data from 1369 lesions were analyzed. Mismatch lesion was defined as the difference between proximal and distal reference lumen diameters of ≥1.0 mm or ≥30% of the distal reference lumen diameter.Results:The incidence of mismatch lesions was 20.1% (275/1369). Compared to nonmismatch group, mismatch group had longer lesions (21.3 [6.4] mm vs 18.4 [6.4] mm, P < .001) with smaller minimum lumen diameter (0.87 [0.29] mm vs 1.10 [0.31] mm, P < .001) and more severe diameter stenosis (78.8% [9.2%] vs 66.3% [10.3%], P < .001). On IVUS, mismatch group had larger lumen area (18.7 [5.0] vs 15.8 [5.1] mm2, P < .001) but lower plaque burden at the proximal reference segment (41.0% [9.2%] vs 45.7% [9.9%], P < .001) and smaller lumen area (4.83 [1.89] vs 7.36 [2.89] mm, P < .001) but higher plaque burden at the distal reference segment (42.9% [10.4%] vs 41.4% [10.1%], P = .023). Multivariable logistic regression analysis showed that mismatch lesions were frequently accompanied by diffuse lesions (odds ratio [OR] = 2.50; 95% confidence interval [CI]: 1.83-3.40; P < .001), bifurcation lesions (OR = 5.83; 95% CI: 4.40-7.74; P < .001), and lesions with a low TIMI flow grade (OR = 1.70; 95% CI: 1.08-2.67; P = .022) or severe diameter stenosis (OR = 3.05; 95% CI: 2.10-4.43; P < .001).Conclusions:Mismatch lesions are quite common and characterized by greater lesion complexity compared with nonmismatch lesions. Further studies may be necessary to address the impact of this lesion type on the outcome of PCI.

Imaging Characteristics and Significance of Coronary Artery Mismatch Lesions

“…9 The geometrical effects on a lower FFR were supported by the computational simulation. 9 The multiple local geometric factors involved in CAD lesions appear to play a significant role in the significance of MCL as reported by Phan et al 1…”

“…In their article on the angiographic and intravascular ultrasound (IVUS) imaging characteristics of mismatch coronary lesions (MCLs), Phan et al emphasize how common MCLs are and how these lesions offer many challenging characteristics for the interventionalist performing a percutaneous coronary intervention (PCI). 1 The definition of MCL is a coronary artery lesion that has a significant difference in plaque burden between the distal and proximal segments. The authors found, by coronary angiography (CAG), a 24.1% incidence of mismatch lesions (411/1706 lesions) and reported that the mismatch lesions were longer than non-mismatch lesions (22.1 + 6.6 mm vs 18.7 + 6.4 mm, respectively; P < .001) and that they also had a smaller minimum lumen diameter by CAG (0.66 + 0.44 vs 0.98 + 0.45, respectively; P < .001).…”

“…The authors found, by coronary angiography (CAG), a 24.1% incidence of mismatch lesions (411/1706 lesions) and reported that the mismatch lesions were longer than non-mismatch lesions (22.1 + 6.6 mm vs 18.7 + 6.4 mm, respectively; P < .001) and that they also had a smaller minimum lumen diameter by CAG (0.66 + 0.44 vs 0.98 + 0.45, respectively; P < .001). 1 With IVUS, the mismatch group was reported to have a larger lumen diameter (3.65 + 0.52 mm vs 3.22 + 0.53 mm, respectively; P < .001), but with a lower plaque burden (41.4% + 9.4% vs 46.1% + 9.9%, respectively; P < .001), at the proximal reference segment of the lesion, whereas at the distal reference segment, there was a smaller lumen diameter (2.43 + 0.49 mm vs 2.99 + 0.59 mm, respectively; P < .001). 1 In turn, by IVUS, there was a larger plaque burden at the distal segment (43.3% + 10.4% vs 41.6% + 10.3%, P ¼ .004).…”

“…1 With IVUS, the mismatch group was reported to have a larger lumen diameter (3.65 ± 0.52 mm vs 3.22 ± 0.53 mm, respectively; P < .001), but with a lower plaque burden (41.4% ± 9.4% vs 46.1% ± 9.9%, respectively; P < .001), at the proximal reference segment of the lesion, whereas at the distal reference segment, there was a smaller lumen diameter (2.43 ± 0.49 mm vs 2.99 ± 0.59 mm, respectively; P < .001). 1 In turn, by IVUS, there was a larger plaque burden at the distal segment (43.3% ± 10.4% vs 41.6% ± 10.3%, P = .004). Phan et al showed by multivariate analysis that mismatch lesions are more likely associated with a severe stenosis, a bifurcation lesion, a chronic total occlusion, and a diffuse lesion.…”

“…Phan et al showed by multivariate analysis that mismatch lesions are more likely associated with a severe stenosis, a bifurcation lesion, a chronic total occlusion, and a diffuse lesion. 1 Therefore, the major significance of MCLs is the increased potential for PCI complications, thus identifying a need for additional study to assess optimal PCI techniques and approaches.…”