Author + information
- Received December 10, 2007
- Revision received January 31, 2008
- Accepted February 7, 2008
- Published online April 1, 2008.
- Bas L. van der Hoeven, MD⁎,
- Su-San Liem, MD⁎,
- Jouke Dijkstra, MSc†,
- Sandrin C. Bergheanu, MD⁎,
- Hein Putter, MSc‡,
- M. Louisa Antoni, MD⁎,
- Douwe E. Atsma, MD⁎,
- Marianne Bootsma, MD⁎,
- Katja Zeppenfeld, MD⁎,
- J. Wouter Jukema, MD⁎ and
- Martin J. Schalij, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Martin J. Schalij, Department of Cardiology, C5-P, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, the Netherlands.
Objectives Acute and late stent malapposition (SM) after bare-metal stents (BMS) and sirolimus-eluting stents (SES) in ST-segment elevation myocardial infarction patients were studied.
Background Stent thrombosis may be caused by SM after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients.
Methods Post-procedure and follow-up intravascular ultrasound data were available in 184 out of 310 patients (60%; 104 SES, 80 BMS) included in the MISSION! Intervention Study. To determine the contribution of remodeling and changes in plaque burden to the change in lumen cross-sectional area (CSA) at SM sites, the change in lumen CSA (follow-up minus post-lumen CSA) was related to the change in external elastic membrane CSA (remodeling) and change in plaque and media CSA (plaque burden).
Results Acute SM was found in 38.5% SES patients and 33.8% BMS patients (p = 0.51), late SM in 37.5% SES patients and 12.5% BMS patients (p < 0.001). Acquired SM was found in 25.0% SES patients and 5.0% BMS patients (p < 0.001). Predictors of acute SM were reference diameter (SES: odds ratio [OR] 3.49, 95% confidence interval [CI] 1.29 to 9.43; BMS: OR 28.8, 95% CI 4.25 to 94.5) and balloon pressure (BMS: OR 0.74, 95% CI 0.58 to 0.94). Predictors of late SM were diabetes mellitus (SES: OR 0.16, 95% CI 0.02 to 1.35), reference diameter (BMS: OR 19.2, 95% CI 2.64 to 139.7), and maximum balloon pressure (BMS: OR 0.74, 95% CI 0.55 to 1.00). Change in lumen CSA was related to change in external elastic membrane CSA (R = 0.73, 95% CI 0.62 to 0.84) after SES implantation and to change in plaque and media CSA (R = −0.62, 95% CI −0.77 to −0.46) after BMS implantation. After SES implantation, acquired SM was caused by positive remodeling in 84% and plaque reduction in 16% of patients.
Conclusions Acute SM was common after SES and BMS stent implantation in ST-segment elevation myocardial infarction patients. After SES implantation, late acquired SM is common and generally caused by positive remodeling. (The MISSION! Intervention Study, ISRCTN62825862)
Supported by the Netherlands Heart Foundation and by an unrestricted research grant from Guidant Inc., Nieuwegein, the Netherlands. Dr. Jukema is an established clinical investigator of the Netherlands Heart Foundation (Grant 2001D032).
- Received December 10, 2007.
- Revision received January 31, 2008.
- Accepted February 7, 2008.
- American College of Cardiology Foundation