Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy

A Randomized Trial

Seung Yul Lee, Jung Sun Kim, Hyuck Jun Yoon, Seung Ho Hur, Sang Gon Lee, Jin Won Kim, Young Joon Hong, Ki Seok Kim, So Yeon Choi, Dong Ho Shin, Chung Mo Nam, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Myeongki Hong

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage. Background: Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited. Methods: A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6% uncovered) on 3-month follow-up OCT. Results: Three-month follow-up OCT data were acquired for 779 patients (87.1%). The median percentage of uncovered struts at 3 months was 8.9% and 8.2% in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009). Favorable early strut coverage (≤6% uncovered strut) was observed in 320 of 779 patients (41.1%). At 12 months, the composite event rarely occurred in the 3-month (0.3%) or 12-month (0.2%) DAPT groups (p = 0.80). Conclusions: OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups. Short-term DAPT may be feasible in selected patients with favorable early strut coverage (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of The Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus-eluting Stents Versus Biolimus A9-eluting Stents [DETECT-OCT]; NCT01752894)

Original languageEnglish
Pages (from-to)1810-1819
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume11
Issue number12
DOIs
Publication statusPublished - 2018 Dec 1

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Drug-Eluting Stents
Optical Coherence Tomography
Stents
Angiography
Therapeutics
Group Psychotherapy
Multicenter Studies
Thrombosis
Myocardial Infarction
Everolimus
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Seung Yul ; Kim, Jung Sun ; Yoon, Hyuck Jun ; Hur, Seung Ho ; Lee, Sang Gon ; Kim, Jin Won ; Hong, Young Joon ; Kim, Ki Seok ; Choi, So Yeon ; Shin, Dong Ho ; Nam, Chung Mo ; Kim, Byeong Keuk ; Ko, Young Guk ; Choi, Donghoon ; Jang, Yangsoo ; Hong, Myeongki. / Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy : A Randomized Trial. In: JACC: Cardiovascular Imaging. 2018 ; Vol. 11, No. 12. pp. 1810-1819.
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abstract = "Objectives: This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage. Background: Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited. Methods: A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6{\%} uncovered) on 3-month follow-up OCT. Results: Three-month follow-up OCT data were acquired for 779 patients (87.1{\%}). The median percentage of uncovered struts at 3 months was 8.9{\%} and 8.2{\%} in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5{\%}) than in the angiography-guided group (9.9{\%}; p = 0.009). Favorable early strut coverage (≤6{\%} uncovered strut) was observed in 320 of 779 patients (41.1{\%}). At 12 months, the composite event rarely occurred in the 3-month (0.3{\%}) or 12-month (0.2{\%}) DAPT groups (p = 0.80). Conclusions: OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups. Short-term DAPT may be feasible in selected patients with favorable early strut coverage (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of The Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus-eluting Stents Versus Biolimus A9-eluting Stents [DETECT-OCT]; NCT01752894)",
author = "Lee, {Seung Yul} and Kim, {Jung Sun} and Yoon, {Hyuck Jun} and Hur, {Seung Ho} and Lee, {Sang Gon} and Kim, {Jin Won} and Hong, {Young Joon} and Kim, {Ki Seok} and Choi, {So Yeon} and Shin, {Dong Ho} and Nam, {Chung Mo} and Kim, {Byeong Keuk} and Ko, {Young Guk} and Donghoon Choi and Yangsoo Jang and Myeongki Hong",
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Lee, SY, Kim, JS, Yoon, HJ, Hur, SH, Lee, SG, Kim, JW, Hong, YJ, Kim, KS, Choi, SY, Shin, DH, Nam, CM, Kim, BK, Ko, YG, Choi, D, Jang, Y & Hong, M 2018, 'Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy: A Randomized Trial', JACC: Cardiovascular Imaging, vol. 11, no. 12, pp. 1810-1819. https://doi.org/10.1016/j.jcmg.2017.12.014

Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy : A Randomized Trial. / Lee, Seung Yul; Kim, Jung Sun; Yoon, Hyuck Jun; Hur, Seung Ho; Lee, Sang Gon; Kim, Jin Won; Hong, Young Joon; Kim, Ki Seok; Choi, So Yeon; Shin, Dong Ho; Nam, Chung Mo; Kim, Byeong Keuk; Ko, Young Guk; Choi, Donghoon; Jang, Yangsoo; Hong, Myeongki.

In: JACC: Cardiovascular Imaging, Vol. 11, No. 12, 01.12.2018, p. 1810-1819.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy

T2 - A Randomized Trial

AU - Lee, Seung Yul

AU - Kim, Jung Sun

AU - Yoon, Hyuck Jun

AU - Hur, Seung Ho

AU - Lee, Sang Gon

AU - Kim, Jin Won

AU - Hong, Young Joon

AU - Kim, Ki Seok

AU - Choi, So Yeon

AU - Shin, Dong Ho

AU - Nam, Chung Mo

AU - Kim, Byeong Keuk

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Jang, Yangsoo

AU - Hong, Myeongki

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objectives: This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage. Background: Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited. Methods: A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6% uncovered) on 3-month follow-up OCT. Results: Three-month follow-up OCT data were acquired for 779 patients (87.1%). The median percentage of uncovered struts at 3 months was 8.9% and 8.2% in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009). Favorable early strut coverage (≤6% uncovered strut) was observed in 320 of 779 patients (41.1%). At 12 months, the composite event rarely occurred in the 3-month (0.3%) or 12-month (0.2%) DAPT groups (p = 0.80). Conclusions: OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups. Short-term DAPT may be feasible in selected patients with favorable early strut coverage (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of The Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus-eluting Stents Versus Biolimus A9-eluting Stents [DETECT-OCT]; NCT01752894)

AB - Objectives: This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage. Background: Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited. Methods: A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6% uncovered) on 3-month follow-up OCT. Results: Three-month follow-up OCT data were acquired for 779 patients (87.1%). The median percentage of uncovered struts at 3 months was 8.9% and 8.2% in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009). Favorable early strut coverage (≤6% uncovered strut) was observed in 320 of 779 patients (41.1%). At 12 months, the composite event rarely occurred in the 3-month (0.3%) or 12-month (0.2%) DAPT groups (p = 0.80). Conclusions: OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups. Short-term DAPT may be feasible in selected patients with favorable early strut coverage (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of The Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus-eluting Stents Versus Biolimus A9-eluting Stents [DETECT-OCT]; NCT01752894)

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