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
The risk of developing late acquired stent malapposition (LASM) after drug-eluting stent (DES) implantation in the clinical setting of a ST-segment Elevation Myocardial Infarction (STEMI) is high due to dissolution of initially jailed thrombus. LASM is a potential risk factor in the subsequent development of later major adverse cardiac events (MACE). The 5-year clinical impact of intravascular ultrasound (IVUS) detected 12-month LASM 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 (57 BESs and 59 SESs) where post-procedure and 12-month follow-up IVUS-data were available. LASM was defined as stent malapposition not present post-procedure but at 12-month follow-up. The possible correlation between IVUS-detected 12-month LASM 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 LASM-group (19 patients) versus the non-LASM-group (97 patients); 10.5% vs. 12.4%, p=0.59. Neither, were there any differences when evaluating the occurrence of the 5-year prevalence of MI: 10.5% vs. 7.2%, p=0.45; TLR: 10.5% vs. 6.2%, p=0.39; TVR: 15.8% vs. 10.3%, p=0.36; all-cause mortality: 0.0% vs. 5.2%, p=0.40; cardiac death: 0.0% vs. 1.0%, p=0.84, and VLST: 5.3% vs. 1.0%, p=0.30, respectively, in the LASM-group vs. the non-LASM-group.
The presence of 12-month LASM did not influence on the 5-year MACE rate. Other arterial healing factors such as heterogeneous coverage, chronic inflammation and hypersensitivity reactions might play important co-predisposing roles in DES-treated STEMI-patients who subsequently suffer from MACE.