Late stent malapposition after drug-eluting stent implantation - An intravascular ultrasound analysis with long-term follow-up
Late stent malapposition after drug-eluting stent implantation - An intravascular ultrasound analysis with long-term follow-up
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DOI：
10.1161/circulationaha.105.563403
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发表时间：
2006-01-24
期刊：
影响因子：
37.8
通讯作者：
Park, SJ
中科院分区：
文献类型：
--
作者：
Hong, MK;Mintz, GS;Park, SJ
背景-药物洗脱支架（DES）植入后的晚期支架贴壁不良（LSM）在现实实践中尚未得到充分评价。方法和结果-我们评价了557例患者DES植入后LSM的发生率、机制、预测因素和长期预后（705处自体病变; 538处病变使用西罗莫司洗脱支架，167处病变使用紫杉醇洗脱支架），在首次和6个月随访时进行了血管内超声检查。82例患者共85个病灶发生LSM（总体12.1%，95% CI 9.7%-14.5%，西罗莫司洗脱支架组71处病变（13.2%），紫杉醇洗脱支架组14处病变[8.4%]，P = 0.12];冠状动脉粥样硬化斑块旋切术后支架置入术前的发生率为25.0%（4/16），慢性完全闭塞病变的发生率为27.5%（14/51），急性心肌梗死患者直接支架术后为31.8%（7/22）（分别为P < 0.13、P <0.001和P = 0.001，而常规球囊预扩张的择期支架术为9.7% [60/616]）。外弹性膜面积的增加（从17.1 ± 3.6到21.4 ± 4.8 mm（2），P < 0.001）大于斑块面积的增加（从9.3 ± 2.5到10.5 ± 2.7 mm（2），P < 0.001）。LSM的独立预测因子为总支架长度、急性心肌梗死的初次支架植入术和慢性完全闭塞病变。除非LSM组1例死亡外，在检测LSM后平均10个月的随访期间，LSM或非LSM患者均未发生重大不良心脏事件。结论-DES植入后12%的病例发生LSM。LSM的预测因子是总支架长度、急性心肌梗死的初次支架植入术和慢性完全闭塞病变。在随后的10个月（平均）随访期间，DES植入后的LSM与任何重大不良心脏事件无关。
Background - Late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated sufficiently in real-world practice.Methods and Results - We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after DES implantation in 557 patients (705 native lesions; sirolimus-eluting stent in 538 lesions and paclitaxel-eluting stent in 167 lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM occurred in 82 patients with 85 lesions (12.1% overall, 95% CI 9.7% to 14.5%, 71 lesions (13.2%) in sirolimus-eluting stents and 14 lesions [8.4%] in paclitaxel-eluting stents, P = 0.12]; the incidence was 25.0% (4/16) after directional coronary atherectomy before stenting, 27.5% (14/51) in chronic total occlusion lesions, and 31.8% (7/22) after primary stenting in acute myocardial infarction (P < 0.13, P < .001, and P = 0.001, respectively, versus elective stenting with conventional balloon predilation, 9.7% [60/616]). There was an increase of external elastic membrane area (from 17.1 +/- 3.6 to 21.4 +/- 4.8 mm(2), P < 0.001) that was greater than the increase in plaque area (from 9.3 +/- 2.5 to 10.5 +/- 2.7 mm(2), P < 0.001). Independent predictors of LSM were total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. Except for 1 death in the non-LSM group, there were no major adverse cardiac events in either LSM or non- LSM patients during a mean 10-month follow-up after detection of LSM.Conclusions - LSM occurs in 12% of cases after DES implantation. The predictors of LSM are total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. LSM after DES implantation was not associated with any major adverse cardiac events during a subsequent 10-month (mean) follow-up.