title: Self-expanding versus balloon-expandable stents in acute myocardial infarction: results from the APPOSITION II study: self-expanding stents in ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  This study sought to investigate whether self-expanding stents are more effective than balloon-expandable stents for reducing stent malapposition at 3 days after implantation in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
  
  
  BACKGROUND
  Acute myocardial infarction is associated with vasoconstriction and large thrombus burden. Resolution of vasoconstriction and thrombus load during the first hours to days after primary percutaneous coronary intervention may lead to stent undersizing and malapposition, which may subsequently lead to stent thrombosis or restenosis. In addition, aggressive stent deployment may cause distal embolization.
  
  
  METHODS
  Eighty patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were randomized to receive a self-expanding stent (STENTYS, STENTYS SA, Paris, France) (n = 43) or a balloon-expandable stent (VISION, Abbott Vascular, Santa Clara, California; or Driver, Medtronic, Minneapolis, Minnesota) (n = 37) at 9 European centers. The primary endpoint was the proportion of stent strut malapposition at 3 days after implantation measured by optical coherence tomography. Secondary endpoints included major adverse cardiac events (cardiac death, recurrent myocardial infarction, emergent bypass surgery, or clinically driven target lesion revascularization).
  
  
  RESULTS
  At 3 days after implantation, on a per-strut basis, a lower rate of malapposed stent struts was observed by optical coherence tomography in the self-expanding stent group than in the balloon-expandable group (0.58% vs. 5.46%, p < 0.001). On a per-patient basis, none of the patients in the self-expanding stent group versus 28% in the balloon-expandable group presented ≥5% malapposed struts (p < 0.001). At 6 months, major adverse cardiac events were 2.3% versus 0% in the self-expanding and balloon-expandable groups, respectively (p = NS).
  
  
  CONCLUSIONS
  Strut malapposition at 3 days is significantly lower in ST-segment elevation myocardial infarction patients allocated to self-expanding stents when than in those allocated to balloon-expandable stents. The impact of this difference on clinical outcome and the risk of late stent thrombosis need to be evaluated further. (Randomized Comparison Between the STENTYS Self-expanding Coronary Stent and a Balloon-expandable Stent in Acute Myocardial Infarction [APPOSITION II]; NCT01008085).
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.forename: Mathias
authors.initials: M
authors.lastname: Vrolix
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: Eric
authors.initials: E
authors.lastname: Eeckhout
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Reczuch
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.forename: René
authors.initials: R
authors.lastname: Spaargaren
authors.forename: Héctor M
authors.initials: HM
authors.lastname: García-García
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Glenn
authors.initials: G
authors.lastname: Van Langenhove
authors.forename: Stefan
authors.initials: S
authors.lastname: Verheye
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000517:prevention & control; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015607:Stents