期刊
EUROPEAN HEART JOURNAL
卷 33, 期 11, 页码 1334-1343出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehr484
关键词
Coronary artery; Drug-eluting stent; Intravascular ultrasound; Incomplete stent apposition
资金
- Bern University Hospital
- University Hospital Zurich
- Swiss National Science Foundation [33CM30-124112]
- Abbott
- Boston Scientific
- Medtronic
- Johnson and Johnson
- Biosensors
- Cordis
- Swiss National Science Foundation (SNF) [33CM30-124112] Funding Source: Swiss National Science Foundation (SNF)
Late acquired incomplete stent apposition (ISA) is more common after drug-eluting stent (DES) than bare metal stent (BMS) implantation and has been associated with vascular hypersensitivity and stent thrombosis (ST). We investigated the impact of incidentally discovered ISA as assessed by intravascular ultrasound (IVUS) 8 months after DES implantation on the long-term clinical outcome. A total of 194 patients with 221 lesions were prospectively followed through 5 years. At 8 months, IVUS showed evidence of ISA among 37 patients with 39 lesions (18) (mean ISA(max) 4.7 5.0 mm(2)), whereas no ISA was observed among 157 patients with 182 lesions. Incomplete stent apposition was more prevalent among segments treated with sirolimus-eluting (n 103) than paclitaxel-eluting stents (n 118) (27 vs. 9, P 0.001). Between IVUS investigation at the 8-month and 5-year follow-up, major adverse cardiac events occurred more frequently in patients with (18.9, n 7) than without ISA (7.0, n 11) (HR 2.71, 95 CI: 1.056.96, P 0.031). While there were no differences with respect to death, the rate of myocardial infarction was higher among patients with (13.5, n 5) than without ISA (1.9, n 3) (HR 7.53, 95 CI: 1.7931.6, P 0.001). Very late ST was more common among patients with than without ISA [Academic Research Consortium-definite ST:13.5 (n 5) vs. 0.6 (n 1) HR 23.2, 95 CI: 2.65203, P 0.001]. In the present study, the presence of ISA as assessed by IVUS 8 months after DES implantation was associated with a higher rate of myocardial infarction and very late stent thrombosis during long-term follow-up. The prognostic impact of ISA on long-term clinical outcomes requires further investigation.
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