Abstracts
Although the presence of uncovered struts may be associated with occurrence of stent thrombosis, the impact of uncovered struts detected routinely by optical coherence tomography (OCT) on subsequent long-term clinical outcomes remains unclear. The objective of this study was to determine the cut-off value of uncovered struts that predicted adverse clinical outcomes after drug eluting stent (DES) implantation. Major safety events (MSEs, a composite occurrence of cardiovascular death, myocardial infarction, and stent thrombosis) were evaluated in 489 DES-treated patients (535 lesions) during the median 851 days after follow-up OCT. MSEs occurred in six patients (four definite stent thrombosis and two sudden cardiac death). The best cut-off value of percentage of uncovered struts for predicting MSE was 5.9 % using the maximal χ2 method: area under the receiver-operating characteristic curve = 0.779, 95 % confidence interval (CI) = 0.648–0.910, p = 0.019, a sensitivity of 83.3 % and a specificity of 70.3 %. Independent predictors for MSE were post-intervention minimal lumen diameter (odds ratio 0.019, 95 % CI = 0.001–0.513, p = 0.018) and percentage of uncovered struts ≥5.9 % (odds ratio 19.781, 95 % CI = 2.071–188.968, p = 0.010). A greater percentage of uncovered struts (the cut-off value of ≥5.9 % uncovered struts) might be significantly associated with occurrence of MSE after DES implantation.
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References
Farb A, Burke AP, Kolodgie FD, Virmani R (2003) Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation 108:1701–1706
Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R (2007) Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115:2435–2441
Finn AV, Nakazawa G, Joner M, Kolodgie FD, Mont EK, Gold HK, Virmani R (2007) Vascular responses to drug eluting stents: importance of delayed healing. Arterioscler Thromb Vasc Biol 27:1500–1510
Prati F, Regar E, Mintz GS, Arbustini E, Di Mario C, Jang IK, Akasaka T, Costa M, Guagliumi G, Grube E, Ozaki Y, Pinto F, Serruys PW, for the expert’s OCT review document (2010) Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 31:401–415
Guagliumi G, Sirbu V, Musumeci G, Gerber R, Biondi-Zoccai G, Ikejima H, Ladich E, Lortkipanidze N, Matiashvili A, Valsecchi O, Virmani R, Stone GW (2012) Examination of the in vivo mechanisms of late drug-eluting stent thrombosis: findings from optical coherence tomography and intravascular ultrasound imaging. J Am Coll Cardiol Interv 5:12–20
Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351
Vranckx P, Cutlip DE, Mehran R, Kint PP, Silber S, Windecker S, Serruys PW (2010) Myocardial infarction adjudication in contemporary all-comer stent trials: balancing sensitivity and specificity. EuroIntervention 5:871–874
Mauri L, Hsieh WH, Massaro JM, Ho KK, D’Agostino R, Cutlip DE (2007) Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med 356:1020–1029
Kim U, Kim JS, Kim JS, Lee JM, Son JW, Kim J, Ko YG, Choi D, Jang Y (2010) The initial extent of malapposition in ST-elevation myocardial infarction treated with drug-eluting stent: the usefulness of optical coherence tomography. Yonsei Med J 51:332–338
Takano M, Inami S, Jang IK, Yamamoto M, Murakami D, Seimiya K, Ohba T, Mizuno K (2007) Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol 99:1033–1038
Barlis P, Dimopoulos K, Tanigawa J, Dzielicka E, Ferrante G, Del Furia F, Di Mario C (2010) Quantitative analysis of intracoronary optical coherence tomography measurements of stent strut apposition and tissue coverage. Int J Cardiol 141:151–156
Kim BK, Kim JS, Oh C, Ko YG, Choi D, Jang Y, Hong MK (2012) Major determinants for the uncovered stent struts on optical coherence tomography after drug-eluting stent implantation. Int J Cardiovasc Imaging 28:705–714
Kim JS, Hong MK, Fan C, Kim TH, Shim JM, Park SM, Ko YG, Choi D, Jang Y (2010) Intracoronary thrombus formation after drug-eluting stents implantation: optical coherence tomographic study. Am Heart J 159:278–283
Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97:1713–1717
Awata M, Kotani J, Uematsu M, Morozumi T, Watanabe T, Onishi T, Iida O, Sera F, Nanto S, Hori M, Nagata S (2007) Serial angioscopic evidence of incomplete neointimal coverage after sirolimus-eluting stent implantation: comparison with bare-metal stents. Circulation 116:910–916
Yamamoto M, Takano M, Murakami D, Inami T, Kobayashi N, Inami S, Okamatsu K, Ohba T, Ibuki C, Hata N, Seino Y, Jang IK, Mizuno K (2011) The possibility of delayed arterial healing 5 years after implantation of sirolimus-eluting stents: serial observations by coronary angioscopy. Am Heart J 161:1200–1206
Papayannis AC, Cipher D, Banerjee S, Brilakis ES (2013) Optical coherence tomography evaluation of drug-eluting stents: a systematic review. Catheter Cardiovasc Interv 81:481–487
Park SJ, Park D-W, Kim Y-H, Lee SW, Lee CW, Han KH, Park SW, Yun SC, Lee SG, Rha SW, Seong IW, Jeong MH, Hur SH, Lee NH, Yoon J, Yang JY, Lee BK, Choi YJ, Chung WS, Lim DS, Cheong SS, Kim KS, Chae JK, Nah DY, Jeon DS, Seung KB, Jang JS, Park HS, Lee K (2010) Duration of dual antiplatelet therapy after implantation of drug-eluting stents. N Engl J Med 362:1374–1382
Hong MK, Mintz GS, Lee CW, Park DW, Lee SW, Kim YH, Kang DH, Cheong SS, Song JK, Kim JJ, Park SW, Park SJ (2007) Impact of late drug-eluting stent malapposition on 3-year clinical events. J Am Coll Cardiol 50:1515–1516
Holmes DR, Kereiakes DJ, Garg S, Serruys PW, Dehmer GJ, Ellis SG, Williams DO, Kimura T, Moliterno DJ (2010) Stent thrombosis. J Am Coll Cardiol 56:1357–1365
Acknowledgments
This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (No. A085012 and A102064), a grant from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (No. A085136), and the Cardiovascular Research Center, Seoul, Korea.
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Hoyoun Won and Dong-Ho Shin contributed equally to this paper.
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Won, H., Shin, DH., Kim, BK. et al. Optical coherence tomography derived cut-off value of uncovered stent struts to predict adverse clinical outcomes after drug-eluting stent implantation. Int J Cardiovasc Imaging 29, 1255–1263 (2013). https://doi.org/10.1007/s10554-013-0223-9
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DOI: https://doi.org/10.1007/s10554-013-0223-9