1. Differential Vascular Responses to New-Generation Drug-Eluting Stenting According to Clinical Presentation: Three-Month Optical Coherence Tomographic Study.
- Author
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Lee SJ, Hong SJ, Kim BK, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, and Jang Y
- Subjects
- Aged, Angina, Stable diagnostic imaging, Angina, Unstable diagnostic imaging, Coronary Artery Disease diagnostic imaging, Female, Humans, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Percutaneous Coronary Intervention adverse effects, Predictive Value of Tests, Prosthesis Design, Randomized Controlled Trials as Topic, Time Factors, Treatment Outcome, Angina, Stable therapy, Angina, Unstable therapy, Coronary Artery Disease therapy, Coronary Vessels diagnostic imaging, Drug-Eluting Stents, Myocardial Infarction therapy, Percutaneous Coronary Intervention instrumentation, Tomography, Optical Coherence
- 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.
- Published
- 2021
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