Relation between poststenting peristent plaque components and late stent malapposition after drug-eluting stent implantation: virtual histology-intravascular ultrasound analysis.
BACKGROUND
Impact of plaque composition on late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated.


METHODS
We evaluated the relation between plaque components at poststenting peristent area (between external elastic membrane and stent areas) and LSM after DES implantation in 266 patients (314 native lesions; paclitaxel-eluting stent in 205 lesions, sirolimus-eluting stent in 66 lesions, zotarolimus-eluting stent in 32 lesions and everolimus-eluting stent in 11 lesions) in whom virtual-histology intravascular ultrasound was performed at index (poststenting) and follow-up (mean: 11.7 ± 4.8 months).


RESULTS
LSM occurred in 24 patients with 30 lesions (9.6%) and there were no significant differences in the incidences of LSM among 4 DES groups [21/205 (10.2%) in paclitaxel-eluting stent, 6/66 (9.1%) in sirolimus-eluting stent, 2/32 (6.3%) in zotarolimus-eluting stent and 1/11 (9.1%) in everolimus-eluting stent, p=0.5)]. Patients with LSM were presented with more acute myocardial infarction (50% vs. 28%, p=0.026) and were more diabetics (50% vs. 30%, p=0.030) compared with those without LSM. Lesions with LSM had more poststenting peristent %necrotic core (NC) volume compared with those without LSM (25.8 ± 11.1% vs. 21.0 ± 5.7%, p<0.001). Independent predictors of LSM were poststenting peristent %NC volume [odds ratio (OR); 1.216, 95% CI; 1.053-1.405, p=0.008], acute myocardial infarction (OR; 2.897, 95% CI; 1.675-4.118, p=0.029), and diabetes mellitus (OR; 2.413, 95% CI; 1.543-3.996, p=0.038).


CONCLUSIONS
Poststenting peristent NC component especially in patients with acute myocardial infarction and in those with diabetes mellitus is associated with the development of LSM after DES implantation.
Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
Young Joon
YJ
Hong
Myung Ho
MH
Jeong
Yun Ha
YH
Choi
Jin A
JA
Song
Su Young
SY
Jang
Jong Hyun
JH
Yoo
Ji Eun
JE
Song
Ki Hong
KH
Lee
Futoshi
F
Yamanaka
Min Goo
MG
Lee
Keun Ho
KH
Park
Doo Sun
DS
Sim
Nam Sik
NS
Yoon
Hyun Ju
HJ
Yoon
Kye Hun
KH
Kim
Hyung Wook
HW
Park
Ju Han
JH
Kim
Youngkeun
Y
Ahn
Jeong Gwan
JG
Cho
Jong Chun
JC
Park
Jung Chaee
JC
Kang
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus