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Stent implantation may be associated with tissue protrusion (TP), especially in patients with acute coronary syndrome (ACS), but its long-term clinical outcome is unknown. The aim of this study was to evaluate the clinical outcome of ACS patients with TP after second-generation drug-eluting stent (DES) implantation.
We retrospectively evaluated 366 consecutive ACS patients who underwent primary percutaneous coronary intervention (PCI) with a second-generation DES at Nagoya Heart Center. All culprit lesions underwent pre- and post-PCI intravascular ultrasound (IVUS) and were classified according to the presence or absence of post-stent TP.
After primary PCI, 198 lesions (54.1%) displayed TP on IVUS. The incidence of IABP insertion and additional procedures, such as additional prolonged ballooning and thrombectomy after stent implantation to reduce the amount of TP, were significantly higher in patients with TP. Multivariate regression analysis demonstrated that the pre-plaque volume more than 300 mm3 was the only independent predictor of TP (OR=2.262, p-value=0.001).At 12-month follow-up, the incidence of TLR did not differ between the patients with and without TP. The incidence rates of late catch-up phenomenon and recurrence of ACS (r-ACS) over the 36.0-month follow-up were higher in patients with TP than in patients without TP (late catch-up: 11.1% vs. 5.9%; Log lank test; p = 0.081, r-ACS: 7.1% vs. 2.4%; Log lank test; p = 0.043). Cox proportional hazard analysis showed that triple vessel disease (HR=9.258, p = 0.001), TP (HR=3.149, p = 0.008), and reduction rate of low-density lipoprotein cholesterol ≥ 50% (HR=0.184, p = 0.004) were the only independent predictors of r-ACS.
|protrusion (-), N=168||protrusion (+), N=198||p-value|
|Initial TIMI 0/1, %||65.5||67.7||0.117|
|Positive remodeling, %||50.0||56.1||0.146|
|Attenuation plaque, %||86.9||90.9||0.146|
|Additional procedure, %||4.8||15.2||0.001|
|IABP insertion, %||13.7||22.2||0.042|
|Peak CK, U/L||1913±1782||2439±2015||0.075|
IVUS-detected TP after DES implantation may be associated with worse clinical outcomes at long-term follow-up, although TP was not associated with worse short-term clinical outcomes.
CORONARY: Acute Coronary Syndromes