Author + information
- Enrico Romagnoli1,
- Laura Gatto2,
- Alessio La Manna3,
- Francesco Burzotta4,
- Nevio Taglieri5,
- Francesco Saia5,
- Francesco Amico6,
- Valeria Marco1,
- Vito Ramazzotti2,
- Alessandro Di Giorgio7,
- Luca Di Vito1,
- Alberto Boi8,
- Marco Contarini9,
- Fausto Castriota10,
- Gary Mintz11 and
- Francesco Prati1
- 1CLI Foundation, Rome, Italy
- 2San Giovanni Addolorata Hospital, Rome, Italy
- 3University of Catania, CaCnia, Italy
- 4Università Cattolica Del Sacro Cuore, Rome, Italy
- 5Policlinico Sant’Orsola-Malpighi, Bologna, Italy
- 6Presidio Ospedaliero Sant’Elia, Caltanissetta, Italy
- 7Policlinico G. Martino, Messina, Italy
- 8Ospedale Brotzu, Cagliari, Italy
- 9Presidio Ospedaliero Umberto I°, Siracusa, Italy
- 10GVM Care and Research, E. S. Health Science Foundation, Cotignola, Italy
- 11Cardiovascular Research Foundation, New York, New York, United States
Acute Stent Malapposition (ASM)as important determinant of stent thrombosis risk remains controversial.We sought to assess clinical consequences of ASM in the context of the multicenter Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) registry.
From the CLI-OPCI database we retrospectively analyzed prevalence and magnitude of ASM in 1020 stented lesions out of 864 patients and explored possible correlation with outcome.
Post-procedural optical coherence tomography (OCT) revealed a variable grade of ASM in 72.3% of stents without correlation between maximal strut-vessel distance and longitudinal extension (R=0.164, p<0.01). Regardless of its magnitude, ASM did not affect risk of following major cardiac adverse events (MACE); residual ASM was comparable in terms of thickness (median [interquartile range] 0.21 [IQ 0.1-0.4] vs. 0.20 [IQ 0.0-0.3], p=0.397) and length (2.0 [IQ 0.5-4.1] vs. 2.2 [IQ 0.0-5.2], p=0.640) in patients with versus without MACE. Also the ASM cut-offs of >0.2mm in thickness and >2.1mm in length, showing best predictive accuracy for outcome (C-statistic 0.52, CI 95% 0.47-0.58, p=0.394), did not identify patients at increased risk of MACE, including TLR (HR 0.80, CI 95% 0.5-1.4) and stent thrombosis (HR 0.71, CI 95% 0.3-1.5). Likewise, timing to MACE was not influenced by the presence of such an ASM with a similar rate of acute-subacute (HR 1.09, CI 95% 0.6-1.9), late (HR 0.91, CI 95% 0.5-1.8), and very late (HR 1.23, CI 95% 0.5-2.9) events.
ASM was a common finding after stent implantation, but was not associated to increased risk of stent failure during follow-up, regardless of its magnitude.