Author + information
- Received January 15, 2009
- Accepted January 23, 2009
- Published online May 1, 2009.
- Nieves Gonzalo, MD,
- Peter Barlis, MBBS, MPH,
- Patrick W. Serruys, MD, PhD,
- Hector M. Garcia-Garcia, MD, MSc,
- Yoshinobu Onuma, MD,
- Jurgen Ligthart, BSc and
- Evelyn Regar, MD, PhD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Evelyn Regar, Thoraxcenter, Bd 585, Dr. Molewaterplein 40, 3015-GD Rotterdam, the Netherlands
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.
- drug-eluting stents
- optical coherence tomography
- stent apposition
- stent coverage
- ST-segment elevation myocardial infarction
- Received January 15, 2009.
- Accepted January 23, 2009.
- American College of Cardiology Foundation