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Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial In

Abstract：

BACKGROUND:The safety of drug-eluting stents in ST-segment elevation myocardial infarction (STEMI) continues to be debated. Pathological studies have demonstrated an association between uncovered struts and subsequent stent thrombosis. Optical coherence tomography can detect stent strut coverage in vivo on a micron-scale level. We therefore used optical coherence tomography to examine strut coverage in patients with STEMI treated with paclitaxel-eluting stents (PES) and bare metal stents (BMS). METHODS AND RESULTS:In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, patients with STEMI were randomized 3:1 to PES or BMS implantation. In a formal substudy, optical coherence tomography at 13 months was performed in 118 consecutive randomized patients (89 PES, 29 BMS) in whom 188 stents were assessed (146 PES and 42 BMS). A total of 44 139 stent struts were analyzed by an independent core laboratory blinded to stent assignment. The primary prespecified end point, the percentage of uncovered stent struts per lesion at follow-up, was 1.1 ± 2.5% in BMS lesions versus 5.7 ± 7.0% in PES lesions (P < 0.0001). Malapposed struts were observed in 0.1 ± 0.2% of BMS lesions versus 0.9 ± 2.1% of PES lesions (P = 0.0003). Percentage net volume obstruction was 36.0 ± 15.4% with BMS and 19.2 ± 11.3% with PES (P < 0.0001). CONCLUSIONS:In patients with STEMI undergoing primary percutaneous coronary intervention, implantation of PES as compared with BMS significantly reduces neointimal hyperplasia but results in higher rates of uncovered and malapposed stent struts as assessed by optical coherence tomography at 13-month follow-up. Further studies are required to determine the clinical significance of these findings. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

journal_name

Circulation

journal_title

Circulation

authors

Guagliumi G,Costa MA,Sirbu V,Musumeci G,Bezerra HG,Suzuki N,Matiashvili A,Lortkipanidze N,Mihalcsik L,Trivisonno A,Valsecchi O,Mintz GS,Dressler O,Parise H,Maehara A,Cristea E,Lansky AJ,Mehran R,Stone GW

doi

10.1161/CIRCULATIONAHA.110.963181

subject

Has Abstract

pub_date

2011-01-25 00:00:00

pages

274-81

issue

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.110.963181

journal_volume

123

pub_type

杂志文章,多中心研究,随机对照试验

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Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial In