title: Impact of incomplete stent apposition on long-term clinical outcome after drug-eluting stent implantation.
abstract: OBJECTIVE
  Late acquired incomplete stent apposition (ISA) is more common after drug-eluting stent (DES) than bare metal stent (BMS) implantation and has been associated with vascular hypersensitivity and stent thrombosis (ST). We investigated the impact of incidentally discovered ISA as assessed by intravascular ultrasound (IVUS) 8 months after DES implantation on the long-term clinical outcome.
  
  
  RESULTS
  A total of 194 patients with 221 lesions were prospectively followed through 5 years. At 8 months, IVUS showed evidence of ISA among 37 patients with 39 lesions (18%) (mean ISA(max) 4.7 ± 5.0 mm(2)), whereas no ISA was observed among 157 patients with 182 lesions. Incomplete stent apposition was more prevalent among segments treated with sirolimus-eluting (n = 103) than paclitaxel-eluting stents (n = 118) (27 vs. 9%, P = 0.001). Between IVUS investigation at the 8-month and 5-year follow-up, major adverse cardiac events occurred more frequently in patients with (18.9%, n = 7) than without ISA (7.0%, n = 11) (HR = 2.71, 95% CI: 1.05-6.96, P = 0.031). While there were no differences with respect to death, the rate of myocardial infarction was higher among patients with (13.5%, n = 5) than without ISA (1.9%, n = 3) (HR = 7.53, 95% CI: 1.79-31.6, P = 0.001). Very late ST was more common among patients with than without ISA [Academic Research Consortium-definite ST:13.5% (n = 5) vs. 0.6% (n = 1) HR = 23.2, 95% CI: 2.65-203, P < 0.001].
  
  
  CONCLUSIONS
  In the present study, the presence of ISA as assessed by IVUS 8 months after DES implantation was associated with a higher rate of myocardial infarction and very late stent thrombosis during long-term follow-up. The prognostic impact of ISA on long-term clinical outcomes requires further investigation.
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Cook
authors.forename: Parham
authors.initials: P
authors.lastname: Eshtehardi
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Mario
authors.initials: M
authors.lastname: Togni
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.forename: Rolf
authors.initials: R
authors.lastname: Vogel
authors.forename: Christian
authors.initials: C
authors.lastname: Seiler
authors.forename: Franz R
authors.initials: FR
authors.lastname: Eberli
authors.forename: Thomas
authors.initials: T
authors.lastname: Lüscher
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D011475:Prosthesis Failure; D016037:Single-Blind Method; D020123:Sirolimus / Q000008:administration & dosage; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage; D018084:Ultrasonography, Interventional
chemical_list: D007166:Immunosuppressive Agents; D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus