Late stent malapposition after drug-eluting stent implantation: An intravascular ultrasound analysis with long-term follow-up

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

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Abstract

BACKGROUND-: Late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated sufficiently in real-world practice. METHODS AND RESULTS-: We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after DES implantation in 557 patients (705 native lesions; sirolimus-eluting stent in 538 lesions and paclitaxel-eluting stent in 167 lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM occurred in 82 patients with 85 lesions (12.1% overall, 95% CI 9.7% to 14.5%, 71 lesions (13.2%) in sirolimus-eluting stents and 14 lesions [8.4%] in paclitaxel-eluting stents, P=0.12]; the incidence was 25.0% (4/16) after directional coronary atherectomy before stenting, 27.5% (14/51) in chronic total occlusion lesions, and 31.8% (7/22) after primary stenting in acute myocardial infarction (P=0.13, P<0.001, and P=0.001, respectively, versus elective stenting with conventional balloon predilation, 9.7% [60/616]). There was an increase of external elastic membrane area (from 17.1±3.6 to 21.4±4.8 mm2, P<0.001) that was greater than the increase in plaque area (from 9.3±2.5 to 10.5±2.7 mm2, P<0.001). Independent predictors of LSM were total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. Except for 1 death in the non-LSM group, there were no major adverse cardiac events in either LSM or non-LSM patients during a mean 10-month follow-up after detection of LSM. CONCLUSIONS-: LSM occurs in 12% of cases after DES implantation. The predictors of LSM are total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. LSM after DES implantation was not associated with any major adverse cardiac events during a subsequent 10-month (mean) follow-up.

Original languageEnglish
Pages (from-to)414-419
Number of pages6
JournalCirculation
Volume113
Issue number3
DOIs
Publication statusPublished - 2006 Jan 1

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Drug-Eluting Stents
Stents
Myocardial Infarction
Sirolimus
Paclitaxel
Coronary Atherectomy
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hong, Myeong Ki ; Mintz, Gary S. ; Lee, Cheol Whan ; Park, Duk Woo ; Park, Kyoung Min ; Lee, Bong Ki ; Kim, Young Hak ; Song, Jong Min ; Han, Ki Hoon ; Kang, Duk Hyun ; Cheong, Sang Sig ; Song, Jae Kwan ; Kim, Jae Joong ; Park, Seong Wook ; Park, Seung Jung. / Late stent malapposition after drug-eluting stent implantation : An intravascular ultrasound analysis with long-term follow-up. In: Circulation. 2006 ; Vol. 113, No. 3. pp. 414-419.
@article{2f11ed423d554dd0a3f9c0c20a9f748d,
title = "Late stent malapposition after drug-eluting stent implantation: An intravascular ultrasound analysis with long-term follow-up",
abstract = "BACKGROUND-: Late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated sufficiently in real-world practice. METHODS AND RESULTS-: We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after DES implantation in 557 patients (705 native lesions; sirolimus-eluting stent in 538 lesions and paclitaxel-eluting stent in 167 lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM occurred in 82 patients with 85 lesions (12.1{\%} overall, 95{\%} CI 9.7{\%} to 14.5{\%}, 71 lesions (13.2{\%}) in sirolimus-eluting stents and 14 lesions [8.4{\%}] in paclitaxel-eluting stents, P=0.12]; the incidence was 25.0{\%} (4/16) after directional coronary atherectomy before stenting, 27.5{\%} (14/51) in chronic total occlusion lesions, and 31.8{\%} (7/22) after primary stenting in acute myocardial infarction (P=0.13, P<0.001, and P=0.001, respectively, versus elective stenting with conventional balloon predilation, 9.7{\%} [60/616]). There was an increase of external elastic membrane area (from 17.1±3.6 to 21.4±4.8 mm2, P<0.001) that was greater than the increase in plaque area (from 9.3±2.5 to 10.5±2.7 mm2, P<0.001). Independent predictors of LSM were total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. Except for 1 death in the non-LSM group, there were no major adverse cardiac events in either LSM or non-LSM patients during a mean 10-month follow-up after detection of LSM. CONCLUSIONS-: LSM occurs in 12{\%} of cases after DES implantation. The predictors of LSM are total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. LSM after DES implantation was not associated with any major adverse cardiac events during a subsequent 10-month (mean) follow-up.",
author = "Hong, {Myeong Ki} and Mintz, {Gary S.} and Lee, {Cheol Whan} and Park, {Duk Woo} and Park, {Kyoung Min} and Lee, {Bong Ki} and Kim, {Young Hak} and Song, {Jong Min} and Han, {Ki Hoon} and Kang, {Duk Hyun} and Cheong, {Sang Sig} and Song, {Jae Kwan} and Kim, {Jae Joong} and Park, {Seong Wook} and Park, {Seung Jung}",
year = "2006",
month = "1",
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doi = "10.1161/CIRCULATIONAHA.105.563403",
language = "English",
volume = "113",
pages = "414--419",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
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Hong, MK, Mintz, GS, Lee, CW, Park, DW, Park, KM, Lee, BK, Kim, YH, Song, JM, Han, KH, Kang, DH, Cheong, SS, Song, JK, Kim, JJ, Park, SW & Park, SJ 2006, 'Late stent malapposition after drug-eluting stent implantation: An intravascular ultrasound analysis with long-term follow-up', Circulation, vol. 113, no. 3, pp. 414-419. https://doi.org/10.1161/CIRCULATIONAHA.105.563403

Late stent malapposition after drug-eluting stent implantation : An intravascular ultrasound analysis with long-term follow-up. / Hong, Myeong Ki; Mintz, Gary S.; Lee, Cheol Whan; Park, Duk Woo; Park, Kyoung Min; Lee, Bong Ki; Kim, Young Hak; Song, Jong Min; Han, Ki Hoon; Kang, Duk Hyun; Cheong, Sang Sig; Song, Jae Kwan; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung.

In: Circulation, Vol. 113, No. 3, 01.01.2006, p. 414-419.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Late stent malapposition after drug-eluting stent implantation

T2 - An intravascular ultrasound analysis with long-term follow-up

AU - Hong, Myeong Ki

AU - Mintz, Gary S.

AU - Lee, Cheol Whan

AU - Park, Duk Woo

AU - Park, Kyoung Min

AU - Lee, Bong Ki

AU - Kim, Young Hak

AU - Song, Jong Min

AU - Han, Ki Hoon

AU - Kang, Duk Hyun

AU - Cheong, Sang Sig

AU - Song, Jae Kwan

AU - Kim, Jae Joong

AU - Park, Seong Wook

AU - Park, Seung Jung

PY - 2006/1/1

Y1 - 2006/1/1

N2 - BACKGROUND-: Late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated sufficiently in real-world practice. METHODS AND RESULTS-: We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after DES implantation in 557 patients (705 native lesions; sirolimus-eluting stent in 538 lesions and paclitaxel-eluting stent in 167 lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM occurred in 82 patients with 85 lesions (12.1% overall, 95% CI 9.7% to 14.5%, 71 lesions (13.2%) in sirolimus-eluting stents and 14 lesions [8.4%] in paclitaxel-eluting stents, P=0.12]; the incidence was 25.0% (4/16) after directional coronary atherectomy before stenting, 27.5% (14/51) in chronic total occlusion lesions, and 31.8% (7/22) after primary stenting in acute myocardial infarction (P=0.13, P<0.001, and P=0.001, respectively, versus elective stenting with conventional balloon predilation, 9.7% [60/616]). There was an increase of external elastic membrane area (from 17.1±3.6 to 21.4±4.8 mm2, P<0.001) that was greater than the increase in plaque area (from 9.3±2.5 to 10.5±2.7 mm2, P<0.001). Independent predictors of LSM were total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. Except for 1 death in the non-LSM group, there were no major adverse cardiac events in either LSM or non-LSM patients during a mean 10-month follow-up after detection of LSM. CONCLUSIONS-: LSM occurs in 12% of cases after DES implantation. The predictors of LSM are total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. LSM after DES implantation was not associated with any major adverse cardiac events during a subsequent 10-month (mean) follow-up.

AB - BACKGROUND-: Late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated sufficiently in real-world practice. METHODS AND RESULTS-: We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after DES implantation in 557 patients (705 native lesions; sirolimus-eluting stent in 538 lesions and paclitaxel-eluting stent in 167 lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM occurred in 82 patients with 85 lesions (12.1% overall, 95% CI 9.7% to 14.5%, 71 lesions (13.2%) in sirolimus-eluting stents and 14 lesions [8.4%] in paclitaxel-eluting stents, P=0.12]; the incidence was 25.0% (4/16) after directional coronary atherectomy before stenting, 27.5% (14/51) in chronic total occlusion lesions, and 31.8% (7/22) after primary stenting in acute myocardial infarction (P=0.13, P<0.001, and P=0.001, respectively, versus elective stenting with conventional balloon predilation, 9.7% [60/616]). There was an increase of external elastic membrane area (from 17.1±3.6 to 21.4±4.8 mm2, P<0.001) that was greater than the increase in plaque area (from 9.3±2.5 to 10.5±2.7 mm2, P<0.001). Independent predictors of LSM were total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. Except for 1 death in the non-LSM group, there were no major adverse cardiac events in either LSM or non-LSM patients during a mean 10-month follow-up after detection of LSM. CONCLUSIONS-: LSM occurs in 12% of cases after DES implantation. The predictors of LSM are total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. LSM after DES implantation was not associated with any major adverse cardiac events during a subsequent 10-month (mean) follow-up.

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