Relation between poststenting peristent plaque components and late stent malapposition after drug-eluting stent implantation: Virtual histology-intravascular ultrasound analysis

• Published in: International journal of cardiology 2013-09, Vol.167 (5), p.1882-1887
• Main Authors: Hong, Young Joon, Jeong, Myung Ho, Choi, Yun Ha, Song, Jin A, Jang, Su Young, Yoo, Jong Hyun, Song, Ji Eun, Lee, Ki Hong, Yamanaka, Futoshi, Lee, Min Goo, Park, Keun Ho, Sim, Doo Sun, Yoon, Nam Sik, Yoon, Hyun Ju, Kim, Kye Hun, Park, Hyung Wook, Kim, Ju Han, Ahn, Youngkeun, Cho, Jeong Gwan, Park, Jong Chun, Kang, Jung Chaee
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; Coronary disease; Coronary heart disease; Drug-Eluting Stents - adverse effects; Everolimus; Female; Follow-Up Studies; Heart; Humans; Malapposition; Male; Medical sciences; Middle Aged; Plaque; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - etiology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Sirolimus - administration & dosage; Sirolimus - analogs & derivatives; Stent; Treatment Outcome; Ultrasonics; Ultrasonography, Interventional - methods
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.04.152

Abstract Background Impact of plaque composition on late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated. Methods We evaluated the relation between plaque components at poststenting peristent area (between external elastic membrane and stent areas) and LSM after DES implantation in 266 patients (314 native lesions; paclitaxel-eluting stent in 205 lesions, sirolimus-eluting stent in 66 lesions, zotarolimus-eluting stent in 32 lesions and everolimus-eluting stent in 11 lesions) in whom virtual-histology intravascular ultrasound was performed at index (poststenting) and follow-up (mean: 11.7 ± 4.8 months). Results LSM occurred in 24 patients with 30 lesions (9.6%) and there were no significant differences in the incidences of LSM among 4 DES groups [21/205 (10.2%) in paclitaxel-eluting stent, 6/66 (9.1%) in sirolimus-eluting stent, 2/32 (6.3%) in zotarolimus-eluting stent and 1/11 (9.1%) in everolimus-eluting stent, p = 0.5)]. Patients with LSM were presented with more acute myocardial infarction (50% vs. 28%, p = 0.026) and were more diabetics (50% vs. 30%, p = 0.030) compared with those without LSM. Lesions with LSM had more poststenting peristent %necrotic core (NC) volume compared with those without LSM (25.8 ± 11.1% vs. 21.0 ± 5.7%, p < 0.001). Independent predictors of LSM were poststenting peristent %NC volume [odds ratio (OR); 1.216, 95% CI; 1.053–1.405, p = 0.008], acute myocardial infarction (OR; 2.897, 95% CI; 1.675–4.118, p = 0.029), and diabetes mellitus (OR; 2.413, 95% CI; 1.543–3.996, p = 0.038). Conclusions Poststenting peristent NC component especially in patients with acute myocardial infarction and in those with diabetes mellitus is associated with the development of LSM after DES implantation.