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

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Hong, M. K., Mintz, G. S., Lee, C. W., Kim, Y. H., Lee, S. W., Song, J. M., Han, K. H., Kang, D. H., Song, J. K., Kim, J. J., Park, S. W., & Park, S. J. (2004). Incidence, Mechanism, Predictors, and Long-Term Prognosis of Late Stent Malapposition after Bare-Metal Stent Implantation. Circulation, 109(7), 881-886. https://doi.org/10.1161/01.CIR.0000116751.88818.10