Author + information
- Lisbeth Antonsen1,
- Evald Christiansen2,
- Michael Maeng3,
- Jan Ravkilde4,
- Knud Noerregaard Hansen5,
- Lars Romer Krusell6,
- Leif Thuesen7,
- Mikkel Hougaard8 and
- Lisette Okkels Jensen9
- 1Department of Cardiology, Odense University Hospital, Odense, Denmark
- 2Aarhus University Hospital, Aarhus, Denmark
- 3Aarhus University Hospital, Aarhus N, Denmark
- 4Alborg University Hospital, Aalborg, Denmark
- 5Odense Universitets Hospital, Odense, Denmark
- 6Aarhus University Hospital Skejby
- 7Cardiac Cath. Lab. Aalborg University Hospital, Denmark, Aalborg, Denmark
- 8Odense Universitetshospital, Odense, Denmark
- 9Odense University Hospital, Odense, Denmark
Heterogeneous culprit lesions in patients with ST-segment Elevation Myocardial Infarctions (STEMI) increase the risk for developing late incomplete stent apposition (ISA) that may cause delayed healing and flow disturbance, and constitute a potential risk factor in subsequent development of later major adverse cardiac events (MACE). The 5-year clinical impact of intravascular ultrasound (IVUS) detected 12-month late ISA in STEMI-patients treated with primary percutaneous coronary intervention and implantation of Biolimus-eluting Nobori (BES) (Terumo, Tokyo, Japan) and Sirolimus-eluting Cypher (SES) (Cordis, Johnson & Johnson, New Jersey, USA) stents was assessed.
In the Randomized Comparison of Biolimus-Eluting Biodegradable Polymer Coated Stent and Durable Polymer Sirolimus-Eluting Stent in Unselected Patients (SORT OUT V) trial, a prespecified IVUS substudy enrolled 116 STEMI-patients where post-procedure and 12-month IVUS-data were available. Late ISA included both persistent ISA (present post-procedure and at 12-month) and late acquired ISA (present only at 12-month). The correlation between IVUS-detected 12-month late ISA and 5-year MACE (composite endpoint of myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), all-cause mortality, cardiac death and very late stent thrombosis (VLST)) was evaluated.
The 5-year MACE-rate did not differ between the late-ISA-group and the non-late-ISA-group; 9.4% vs. 19.4%, p=0.13. However, the 5-year TLR-rate was significantly higher among late ISA-patients; 16.1% vs. 3.5%, p=0.03, and there was a tendency towards a higher 5-year MI- and VLST-rate among late-ISA-patients at 12-month; 16.1% vs. 4.7%, p=0.056, and 6.5% vs. 0.0%, p=0.07, respectively. No correlation between late ISA and 5-year rate of TVR, all-cause mortality, and cardiac death was found; 19.4% vs. 8.2%, p=0.09, 3.2% vs. 4.7%, p=0.60, and 0.0% vs. 1.2%, p=0.73, respectively.
The presence of 12-month late ISA did not influence on the overall 5-year MACE-rate. However, late ISA influenced negatively on the 5-year TLR-rate, and there seemed to be a tendency towards more MIs and VLSTs at 5-year in late-ISA-patients.
CORONARY: PCI Outcomes