We evaluated early vascular responses after new-generation drug-eluting stent (DES) implantation. From 2 randomized trials, we identified 471 patients (138 patients with acute myocardial infarction [AMI] vs 333 patients with stable angina or unstable angina [SA/UA]) treated by DESs who underwent serial optical coherence tomography (OCT) from postprocedure to 3 months. At 3-month follow-up OCT, malapposed strut percentage was higher in AMI than in SA/UA (5.3% vs 0.7%, P <.001); it was markedly increased from postprocedure in AMI (2.0%-5.3%, P <.001), whereas it decreased in SA/UA (1.7%-0.7%, P <.001). Patients with AMI showed a higher risk of persistent (59% vs 37%; P <.001) or late-acquired malapposition (15% vs 8%; P =.04). Uncovered strut percentage at 3 months was also higher in AMI than in SA/UA (13.1% vs 6.7%, P <.001). The AMI presentation was the significant risk factor for both significant stent malapposition (SM, ≥200 μm; odds ratio [OR] = 3.45, CI = 1.85-7.14, P <.001) and uncovered stent (% uncovered struts >6.0%; OR = 2.44, CI = 1.35-4.76, P =.004), together with malapposed distance and postprocedural thrombi. Further, AMI presentation was the predictor for the occurrence of early period late-acquired and persistent malapposition. Serial OCT comparison analyses showed that patients with AMI compared with patients with SA/UA showed more delayed strut coverage, more severe degree SM or uncovered stents, and higher incidences of early period persistent or late-acquired SM.
Bibliographical noteFunding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (no. HI17C0882, HI16C2211, and HI15C2782), the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government (no. 2015M3A9C6031514), and the Cardiovascular Research Center, Seoul, Republic of Korea.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine