Angiographic evidence of progressive lumen narrowing over 2 years following drug-eluting stent implantation.
BACKGROUND
Questions persist regarding the ability of drug-eluting stents (DES) to inhibit intimal growth in the long-term.


METHODS
We prospectively enrolled 766 lesions treated with DES that underwent angiographic examination at 6 months and 2 years after stenting. Lesions with 6-month restenosis (>50% of visual stenosis) were excluded. The primary end point was quantitative change in minimal lumen diameter (MLD) according to serial angiography of the segment (in-segment), the stented region (in-stent) and both edges. Late loss, defined as MLD change, was categorized as early (between post-procedure and 6 months), delayed (between 6 months and 2 years), or overall (between post-procedure and 2-years).


RESULTS
MLD progressively decreased in both the in-stent and edge regions at both 6 months and 2 years (p<0.001 in all paired analyses). In-segment MLD decreased from a median 2.27 mm (interquartile range; 1.98, 2.62) at post-procedure to 2.18 mm (1.86, 2.47; p < 0.001 with post-procedure) at 6 months, and to 2.02 mm (1.66, 2.37; p<0.001 with 6 months) at 2 years. Late loss was 0.0 6 mm (-0.05, 0.26) in the early phase, 0.09 mm (-0.01, 0.28) in the delayed phase, and 0.20mm (0.03, 0.50) overall. Two-year angiographic restenosis occurred in 54 (7.0%) lesions, and 65 (8.5%) underwent target lesion revascularization over a median follow-up of 52.5 months.


CONCLUSIONS
Serial angiographic analysis showed that DES lumen diameter progressively narrowed over 2 years post-procedure. However, the incidence of target lesion revascularization was relatively low due to the small amount of late loss in the delayed phase.
Park
Seung-Jung
SJ
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. sjpark@amc.seoul.kr
Kim
Young-Hak
YH
Kim
Won-Jang
WJ
Ahn
Jung-Min
JM
Yun
Sung-Cheol
SC
Lee
Jong-Young
JY
Park
Duk-Woo
DW
Kang
Soo-Jin
SJ
Lee
Seung-Whan
SW
Lee
Cheol Whan
CW
Park
Seong-Wook
SW
D000368:Aged; D017023:Coronary Angiography / Q000639:trends*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D018450:Disease Progression; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome