TY - JOUR
TI - Mechanisms of Non-Fatal Stent-Related Myocardial Infarction Late
Following Coronary Stenting With Drug-Eluting Stents and Bare Metal
Stents - Insights From Optical Coherence Tomography
AU - Davlouros, Periklis A.
AU - Karantalis, Vasileios
AU - Xanthopoulou,
AU - Ioanna
AU - Mavronasiou, Eleni
AU - Tsigkas, Grigorios
AU - Toutouzas,
AU - Konstantinos
AU - Alexopoulos, Dimitrios
JO - Circulation Journal
PY - 2011
VL - 75
TODO - 12
SP - 2789-2797
PB - JAPANESE CIRCULATION SOC
SN - 1346-9843, 1347-4820
TODO - 10.1253/circj.CJ-11-0581
TODO - Bare metal stent; Drug-eluting stent; Myocardial infarction; Optical
coherence tomography
TODO - Background: A prospective observational study using optical coherence
tomography (OCT) of patients with myocardial infarction (MI), late
following drug-eluting (DES) or bare metal stent (BMS) implantation,
when the stented segment was considered culprit.
Methods and Results: Seventeen patients (58.9 +/- 8.3 years; 7 DES, 10
BMS) with MI at 50 (3-180) months post-stenting. Patients with BMS
sustained a MI later than patients with DES (95 (3-180) vs. 8(3-62)
months, P=0.01]; 5 (71.4%) of the DES patients demonstrated binary
angiographic restenosis, in contrast to 8 (80%) with BMS (P=1.0). DES
had significantly less thickness of the neointimal hyperplasia compared
with BMS (0.08 +/- 0.04 vs. 0.36 +/- 0.2 mm, P=0.003). None of the DES
was totally covered with neointimal tissue. The overall percentage of
uncovered and malapposed struts (ANCOVA), was significantly higher in
DES than BMS (1.96, 95% confidence interval (CI) 1.5-2.4 vs. 0.25,
95%CI 0.1-0.6, P<0.001, and 0.66, 95%CI 0.29-1.03 vs. 0.11, 95%CI
0.19-0.4, P=0.03, respectively). OCT features of atherosclerosis (lipid,
neovascularization, or calcification) and possible neointimal rupture
were found only in patients with BMS. Thrombus detection was not
different between the 2 groups.
Conclusions: Stent-related, non-fatal, late acute MI following stent
implantation occurs later in patients with a BMS compared with those
with a DES, and the mechanism includes delayed healing (mainly DES), and
neointimal hyperplasia with atherosclerotic transformation and
subsequent rupture (mainly BMS). (Circ J 2011; 75: 2789 2797)
ER -