This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gonzalo, N. Articles by Regar, E. Search for Related Content PubMed Articles by Gonzalo, N. Articles by Regar, E.

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