1
|
Lee SJ, Hong SJ, Kim BK, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Differential Vascular Responses to New-Generation Drug-Eluting Stenting According to Clinical Presentation: Three-Month Optical Coherence Tomographic Study. Angiology 2020; 72:381-391. [PMID: 33342226 DOI: 10.1177/0003319720980607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated early vascular responses after new-generation drug-eluting stent (DES) implantation. From 2 randomized trials, we identified 471 patients (138 patients with acute myocardial infarction [AMI] vs 333 patients with stable angina or unstable angina [SA/UA]) treated by DESs who underwent serial optical coherence tomography (OCT) from postprocedure to 3 months. At 3-month follow-up OCT, malapposed strut percentage was higher in AMI than in SA/UA (5.3% vs 0.7%, P < .001); it was markedly increased from postprocedure in AMI (2.0%-5.3%, P < .001), whereas it decreased in SA/UA (1.7%-0.7%, P < .001). Patients with AMI showed a higher risk of persistent (59% vs 37%; P < .001) or late-acquired malapposition (15% vs 8%; P = .04). Uncovered strut percentage at 3 months was also higher in AMI than in SA/UA (13.1% vs 6.7%, P < .001). The AMI presentation was the significant risk factor for both significant stent malapposition (SM, ≥200 μm; odds ratio [OR] = 3.45, CI = 1.85-7.14, P < .001) and uncovered stent (% uncovered struts >6.0%; OR = 2.44, CI = 1.35-4.76, P = .004), together with malapposed distance and postprocedural thrombi. Further, AMI presentation was the predictor for the occurrence of early period late-acquired and persistent malapposition. Serial OCT comparison analyses showed that patients with AMI compared with patients with SA/UA showed more delayed strut coverage, more severe degree SM or uncovered stents, and higher incidences of early period persistent or late-acquired SM.
Collapse
Affiliation(s)
- Seung-Jun Lee
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| | - Sung-Jin Hong
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| | - Byeong-Keuk Kim
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| | - Chul-Min Ahn
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| | - Jung-Sun Kim
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| | - Young-Guk Ko
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| | - Donghoon Choi
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| | - Myeong-Ki Hong
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| | - Yangsoo Jang
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea
| |
Collapse
|