Incidence, Mechanism, Predictors, and Long-Term Prognosis of Late Stent Malapposition after Bare-Metal Stent Implantation

Myeong Ki Hong, Gary S. Mintz, Cheol Whan Lee, Young Hak Kim, Seung Whan Lee, Jong Min Song, Ki Hoon Han, Duk Hyun Kang, Jae Kwan Song, Jae Joong Kim, Seong Wook Park, Seung Jung Park

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Abstract

Background - Predictors and long-term prognosis of late stent malapposition (LSM) after bare-metal stent (BMS) implantation are unknown. Methods and Results - We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after BMS implantation in 881 patients (992 native lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM was defined as a separation of stent struts from the intimal surface of the arterial wall that was not presented at stent implantation. LSM occurred in 54 patients with 54 lesions (5.4% overall); the incidence was 10.3% (9 of 87) after directional coronary atherectomy (DCA) before stenting and 11. 5% (11 of 96) after primary stenting in acute myocardial infarction (P=0.031 and P=0.007, respectively, versus elective stenting with conventional balloon pre-dilation, 4.3% [30 of 692]). There was an increase of external elastic membrane area (18.9±3.9 to 24.5±5.1 mm2, P<0.001) that was greater than the increase in plaque area (9.6±3.0 to 11.4±2.9 MM2, P<0.001). Independent predictors of LSM were primary stenting in acute myocardial infarction (P=0.023, OR=2.55, 95% CI=1.14 to 5.69) and DCA before stenting (P=0.025, OR=3.02, 95% CI=1.15 to 7.96). There were no significant differences in major adverse cardiac events between LSM and non-LSM groups during mean 3-year follow-up (1.9% versus 1.8%, respectively, P=NS). Conclusions - LSM occurs in ≈5% after BMS implantation. The predictors of LSM are primary stenting in acute myocardial infarction and DCA before stenting. Compared with complete stent apposition at follow-up, LSM after BMS implantation is not associated with any major adverse cardiac events during a mean 3-year follow-up after detection of LSM.

Original languageEnglish
Pages (from-to)881-886
Number of pages6
JournalCirculation
Volume109
Issue number7
DOIs
Publication statusPublished - 2004 Feb 24

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Stents
Metals
Incidence
Coronary Atherectomy
Myocardial Infarction
Tunica Intima
Dilatation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hong, Myeong Ki ; Mintz, Gary S. ; Lee, Cheol Whan ; Kim, Young Hak ; Lee, Seung Whan ; Song, Jong Min ; Han, Ki Hoon ; Kang, Duk Hyun ; Song, Jae Kwan ; Kim, Jae Joong ; Park, Seong Wook ; Park, Seung Jung. / Incidence, Mechanism, Predictors, and Long-Term Prognosis of Late Stent Malapposition after Bare-Metal Stent Implantation. In: Circulation. 2004 ; Vol. 109, No. 7. pp. 881-886.
@article{661d82b52f90401aab6f5e5682d8f952,
title = "Incidence, Mechanism, Predictors, and Long-Term Prognosis of Late Stent Malapposition after Bare-Metal Stent Implantation",
abstract = "Background - Predictors and long-term prognosis of late stent malapposition (LSM) after bare-metal stent (BMS) implantation are unknown. Methods and Results - We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after BMS implantation in 881 patients (992 native lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM was defined as a separation of stent struts from the intimal surface of the arterial wall that was not presented at stent implantation. LSM occurred in 54 patients with 54 lesions (5.4{\%} overall); the incidence was 10.3{\%} (9 of 87) after directional coronary atherectomy (DCA) before stenting and 11. 5{\%} (11 of 96) after primary stenting in acute myocardial infarction (P=0.031 and P=0.007, respectively, versus elective stenting with conventional balloon pre-dilation, 4.3{\%} [30 of 692]). There was an increase of external elastic membrane area (18.9±3.9 to 24.5±5.1 mm2, P<0.001) that was greater than the increase in plaque area (9.6±3.0 to 11.4±2.9 MM2, P<0.001). Independent predictors of LSM were primary stenting in acute myocardial infarction (P=0.023, OR=2.55, 95{\%} CI=1.14 to 5.69) and DCA before stenting (P=0.025, OR=3.02, 95{\%} CI=1.15 to 7.96). There were no significant differences in major adverse cardiac events between LSM and non-LSM groups during mean 3-year follow-up (1.9{\%} versus 1.8{\%}, respectively, P=NS). Conclusions - LSM occurs in ≈5{\%} after BMS implantation. The predictors of LSM are primary stenting in acute myocardial infarction and DCA before stenting. Compared with complete stent apposition at follow-up, LSM after BMS implantation is not associated with any major adverse cardiac events during a mean 3-year follow-up after detection of LSM.",
author = "Hong, {Myeong Ki} and Mintz, {Gary S.} and Lee, {Cheol Whan} and Kim, {Young Hak} and Lee, {Seung Whan} and Song, {Jong Min} and Han, {Ki Hoon} and Kang, {Duk Hyun} and Song, {Jae Kwan} and Kim, {Jae Joong} and Park, {Seong Wook} and Park, {Seung Jung}",
year = "2004",
month = "2",
day = "24",
doi = "10.1161/01.CIR.0000116751.88818.10",
language = "English",
volume = "109",
pages = "881--886",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

Hong, MK, Mintz, GS, Lee, CW, Kim, YH, Lee, SW, Song, JM, Han, KH, Kang, DH, Song, JK, Kim, JJ, Park, SW & Park, SJ 2004, 'Incidence, Mechanism, Predictors, and Long-Term Prognosis of Late Stent Malapposition after Bare-Metal Stent Implantation', Circulation, vol. 109, no. 7, pp. 881-886. https://doi.org/10.1161/01.CIR.0000116751.88818.10

Incidence, Mechanism, Predictors, and Long-Term Prognosis of Late Stent Malapposition after Bare-Metal Stent Implantation. / Hong, Myeong Ki; Mintz, Gary S.; Lee, Cheol Whan; Kim, Young Hak; Lee, Seung Whan; Song, Jong Min; Han, Ki Hoon; Kang, Duk Hyun; Song, Jae Kwan; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung.

In: Circulation, Vol. 109, No. 7, 24.02.2004, p. 881-886.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence, Mechanism, Predictors, and Long-Term Prognosis of Late Stent Malapposition after Bare-Metal Stent Implantation

AU - Hong, Myeong Ki

AU - Mintz, Gary S.

AU - Lee, Cheol Whan

AU - Kim, Young Hak

AU - Lee, Seung Whan

AU - Song, Jong Min

AU - Han, Ki Hoon

AU - Kang, Duk Hyun

AU - Song, Jae Kwan

AU - Kim, Jae Joong

AU - Park, Seong Wook

AU - Park, Seung Jung

PY - 2004/2/24

Y1 - 2004/2/24

N2 - Background - Predictors and long-term prognosis of late stent malapposition (LSM) after bare-metal stent (BMS) implantation are unknown. Methods and Results - We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after BMS implantation in 881 patients (992 native lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM was defined as a separation of stent struts from the intimal surface of the arterial wall that was not presented at stent implantation. LSM occurred in 54 patients with 54 lesions (5.4% overall); the incidence was 10.3% (9 of 87) after directional coronary atherectomy (DCA) before stenting and 11. 5% (11 of 96) after primary stenting in acute myocardial infarction (P=0.031 and P=0.007, respectively, versus elective stenting with conventional balloon pre-dilation, 4.3% [30 of 692]). There was an increase of external elastic membrane area (18.9±3.9 to 24.5±5.1 mm2, P<0.001) that was greater than the increase in plaque area (9.6±3.0 to 11.4±2.9 MM2, P<0.001). Independent predictors of LSM were primary stenting in acute myocardial infarction (P=0.023, OR=2.55, 95% CI=1.14 to 5.69) and DCA before stenting (P=0.025, OR=3.02, 95% CI=1.15 to 7.96). There were no significant differences in major adverse cardiac events between LSM and non-LSM groups during mean 3-year follow-up (1.9% versus 1.8%, respectively, P=NS). Conclusions - LSM occurs in ≈5% after BMS implantation. The predictors of LSM are primary stenting in acute myocardial infarction and DCA before stenting. Compared with complete stent apposition at follow-up, LSM after BMS implantation is not associated with any major adverse cardiac events during a mean 3-year follow-up after detection of LSM.

AB - Background - Predictors and long-term prognosis of late stent malapposition (LSM) after bare-metal stent (BMS) implantation are unknown. Methods and Results - We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after BMS implantation in 881 patients (992 native lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM was defined as a separation of stent struts from the intimal surface of the arterial wall that was not presented at stent implantation. LSM occurred in 54 patients with 54 lesions (5.4% overall); the incidence was 10.3% (9 of 87) after directional coronary atherectomy (DCA) before stenting and 11. 5% (11 of 96) after primary stenting in acute myocardial infarction (P=0.031 and P=0.007, respectively, versus elective stenting with conventional balloon pre-dilation, 4.3% [30 of 692]). There was an increase of external elastic membrane area (18.9±3.9 to 24.5±5.1 mm2, P<0.001) that was greater than the increase in plaque area (9.6±3.0 to 11.4±2.9 MM2, P<0.001). Independent predictors of LSM were primary stenting in acute myocardial infarction (P=0.023, OR=2.55, 95% CI=1.14 to 5.69) and DCA before stenting (P=0.025, OR=3.02, 95% CI=1.15 to 7.96). There were no significant differences in major adverse cardiac events between LSM and non-LSM groups during mean 3-year follow-up (1.9% versus 1.8%, respectively, P=NS). Conclusions - LSM occurs in ≈5% after BMS implantation. The predictors of LSM are primary stenting in acute myocardial infarction and DCA before stenting. Compared with complete stent apposition at follow-up, LSM after BMS implantation is not associated with any major adverse cardiac events during a mean 3-year follow-up after detection of LSM.

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