Different patterns of neointimal coverage between acute coronary syndrome and stable angina after various types of drug-eluting stents implantation; 9-month follow-up optical coherence tomography study.
BACKGROUND
Acute coronary syndrome (ACS) is an independent risk factor for late stent thrombosis which might be related to the impaired vascular healing after drug-eluting stent (DES) due to the disruption of plaques and thrombus formation. Therefore, we investigated the vascular response after various DES implantations between ACS and stable angina pectoris (SAP) using optical coherence tomography (OCT).


METHODS
Ninety-one patients [49 ACS: 20 sirolimus-eluting (SES), 12 paclitaxel-eluting (PES) and 17 zotarolimus eluting stent (ZES) and 42 SAP: 15 SES, 12 PES and 15 ZES] underwent OCT at 9 months after stent implantation. Neointimal coverage and malapposition were evaluated in 21,939 struts in 2269-mm stented segments.


RESULTS
In the ACS group, the incidence of uncovered and malapposed struts was significantly higher (8.9 ± 13.7 vs 2.9 ± 6.2%, p = 0.01 and 2.2 ± 5.6 vs 0.5 ± 2.0%, p = 0.02). Among the three DESs tested, SES showed a significantly higher rate of uncovered struts in the ACS group (17.3 ± 13.4 vs 4.4 ± 6.2%, p = 0.003). PES had a trend toward higher rate of uncovered and malapposed struts in the ACS groups (6.7 ± 7.6 vs 4.0 ± 9.0%, p = 0.13) while ZES was similar in both groups.


CONCLUSIONS
The patterns of neointimal coverage and malapposition at 9months after DES implantation were different between ACS and SAP, and variable among the DES type between two groups. Therefore, the present study suggests that vascular response after DES implantation might be influenced by both clinical presentation and type of DES.
Kim
Jung-Sun
JS
Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Fan
Chunyu
C
Choi
Donghoon
D
Jang
Ik-Kyung
IK
Lee
Jung Myung
JM
Kim
Tae Hoon
TH
Park
Sang Min
SM
Paik
Sung Il
SI
Ko
Young-Guk
YG
Hong
Myeong-Ki
MK
Jang
Yangsoo
Y
Chung
Namsik
N
D054058:Acute Coronary Syndrome / Q000473:pathology* / Q000628:therapy*; D000787:Angina Pectoris / Q000473:pathology* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000473:pathology*; D013997:Time Factors; D041623:Tomography, Optical Coherence