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Incomplete Stent Apposition and Delayed Tissue Coverage Are More Frequent in Drug-Eluting Stents Implanted During Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Than in Drug-Eluting Stents Implanted for Stable/Unstable Angina

Insights From Optical Coherence Tomography

Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands

^_* Reprint requests and correspondence: Dr. Evelyn Regar, Thoraxcenter, Bd 585, Dr. Molewaterplein 40, 3015-GD Rotterdam, the Netherlands (Email: e.regar{at}erasmusmc.nl).

Objectives: The aim of this study was to compare the frequency of incomplete stent apposition (ISA) and struts not covered by tissue at long-term follow-up (as assessed by optical coherence tomography [OCT]) in drug-eluting stents (DES) implanted during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) versus DES implanted for unstable and stable angina.

Background: Incomplete stent apposition and the absence of strut endothelialization might be linked to stent thrombosis. DES implanted for STEMI might have a higher risk of thrombosis.

Methods: Consecutive patients in whom OCT was performed at least 6 months after DES implantation were included in the study. Stent struts were classified on the basis of the presence or absence of ISA and tissue coverage.

Results: Forty-seven lesions in 43 patients (1,356 frames, 10,140 struts) were analyzed (49% stable angina, 17% unstable angina, 34% STEMI). Median follow-up time was 9 (range 7 to 72) months. Drug-eluting stents implanted during primary PCI presented ISA more often than DES implanted in stable/unstable angina patients (75% vs. 25.8%, p = 0.001). The frequency of uncovered struts was also higher in the STEMI group (93.8% vs. 67.7%, p = 0.048). On multivariate analysis, DES implantation in STEMI was the only independent predictor of ISA (odds ratio: 9.8, 95% confidence interval: 2.4 to 40.4, p = 0.002) and the presence of uncovered struts at follow-up (odds ratio: 9.5, 95% confidence interval: 1.0 to 90.3, p = 0.049).

Conclusions: DES implanted for STEMI had a higher frequency of incompletely apposed struts and uncovered struts as assessed by OCT at follow-up. DES implantation during primary PCI in STEMI was an independent predictor of ISA and the presence of uncovered struts at follow-up.

Key Words: drug-eluting stents • optical coherence tomography • stent apposition • stent coverage • ST-segment elevation myocardial infarction

Abbreviations and Acronyms   BMS = bare metal stent(s)   DES = drug-eluting stent(s)   ISA = incomplete stent apposition   IVUS = intravascular ultrasound   OCT = optical coherence tomography   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction

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