title: Mechanisms of non-fatal stent-related myocardial infarction late following coronary stenting with drug-eluting stents and bare metal stents. Insights from optical coherence tomography.
abstract: BACKGROUND
  A prospective observational study using optical coherence tomography (OCT) of patients with myocardial infarction (MI), late following drug-eluting (DES) or bare metal stent (BMS) implantation, when the stented segment was considered culprit.
  
  
  RESULTS
  Seventeen patients (58.9±8.3 years; 7 DES, 10 BMS) with MI at 50 (3-180) months post-stenting. Patients with BMS sustained a MI later than patients with DES (95 (3-180) vs. 8 (3-62) months, P=0.01]; 5 (71.4%) of the DES patients demonstrated binary angiographic restenosis, in contrast to 8 (80%) with BMS (P=1.0). DES had significantly less thickness of the neointimal hyperplasia compared with BMS (0.08±0.04 vs. 0.36±0.2mm, P=0.003). None of the DES was totally covered with neointimal tissue. The overall percentage of uncovered and malapposed struts (ANCOVA), was significantly higher in DES than BMS (1.96, 95% confidence interval (CI) 1.5-2.4 vs. 0.25, 95%CI 0.1-0.6, P<0.001, and 0.66, 95%CI 0.29-1.03 vs. 0.11, 95%CI 0.19-0.4, P=0.03, respectively). OCT features of atherosclerosis (lipid, neovascularization, or calcification) and possible neointimal rupture were found only in patients with BMS. Thrombus detection was not different between the 2 groups.
  
  
  CONCLUSIONS
  Stent-related, non-fatal, late acute MI following stent implantation occurs later in patients with a BMS compared with those with a DES, and the mechanism includes delayed healing (mainly DES), and neointimal hyperplasia with atherosclerotic transformation and subsequent rupture (mainly BMS).
authors.affiliation: Patras University Hospital, Patras, Greece.
authors.forename: Periklis A
authors.initials: PA
authors.lastname: Davlouros
authors.forename: Vasileios
authors.initials: V
authors.lastname: Karantalis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Xanthopoulou
authors.forename: Eleni
authors.initials: E
authors.lastname: Mavronasiou
authors.forename: Grigorios
authors.initials: G
authors.lastname: Tsigkas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000097:blood / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D041623:Tomography, Optical Coherence