title: Impact of late incomplete stent apposition after sirolimus-eluting stent implantation on 4-year clinical events: intravascular ultrasound analysis from the multicentre, randomised, RAVEL, E-SIRIUS and SIRIUS trials.
abstract: BACKGROUND
  The impact of incomplete stent apposition (ISA) after drug-eluting stent implantation determined by intravascular ultrasound (IVUS) on late clinical events is not well defined.
  
  
  OBJECTIVE
  To evaluate the clinical impact of ISA after sirolimus-eluting stent (SES) placement during a follow-up period of 4 years.
  
  
  METHODS
  Pooled analysis from the RAVEL, E-SIRIUS and SIRIUS trials, three randomised, multicentre studies comparing SES and bare-metal stents (BMS).
  
  
  METHODS
  IVUS at angiographic follow-up was available in 325 patients (SES: n = 180, BMS: n = 145). IVUS images were reviewed for the presence of ISA defined as one or more unapposed stent struts. Clinical follow-up was available for a 4-year period in all patients. Frequency, predictors and clinical sequel of ISA at follow-up after SES and BMS implantation were determined.
  
  
  RESULTS
  ISA at follow-up was more common after SES (n = 45 (25%)) than after BMS (n = 12 (8.3%), p<0.001). Canadian Cardiology Society class III or IV angina at stent implantation (odds ratio (OR) = 4.69, 95% CI 2.15 to 10.23, p<0.001) and absence of diabetes (OR = 3.42, 95% CI 1.05 to 11.1, p = 0.041) were predictors of ISA at follow-up after SES placement. Rate of myocardial infarction tended to be slightly higher for ISA than for non-ISA patients. When SES patients only were considered, major adverse cardiac event free survival at 4 years was identical for those with and without ISA at follow-up (11.1% vs 16.3%, p = 0.48).
  
  
  CONCLUSIONS
  ISA at follow-up is more common after SES implantation than after BMS implantation. Considering the current very sensitive IVUS definition, ISA appears to be an IVUS finding without significant impact on the incidence of major adverse cardiac events even during long-term follow-up.
authors.affiliation: University Hospital Aachen, Aachen, Germany. RHoffmann@UKAACHEN.de
authors.forename: R
authors.initials: R
authors.lastname: Hoffmann
authors.forename: M-C
authors.initials: MC
authors.lastname: Morice
authors.forename: J W
authors.initials: JW
authors.lastname: Moses
authors.forename: P J
authors.initials: PJ
authors.lastname: Fitzgerald
authors.forename: L
authors.initials: L
authors.lastname: Mauri
authors.forename: G
authors.initials: G
authors.lastname: Breithardt
authors.forename: J
authors.initials: J
authors.lastname: Schofer
authors.forename: P W
authors.initials: PW
authors.lastname: Serruys
authors.forename: H-P
authors.initials: HP
authors.lastname: Stoll
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage; D013997:Time Factors; D050257:Tubulin Modulators / Q000008:administration & dosage; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D050257:Tubulin Modulators; D020123:Sirolimus