title: Incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by optical coherence tomography after drug-eluting stent implantation.
abstract: BACKGROUND
  We investigated the incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by optical coherence tomography (OCT) after drug-eluting stent implantation.
  
  
  RESULTS
  We analyzed the OCT images from 351 patients with 356 lesions who received poststent and follow-up OCT examinations. Acute stent malapposition was observed in 62% of lesions. Approximately half of the acute stent malappositions were located within the edges of the stents. Severe diameter stenosis, calcified lesions, and long stents were independent predictors of acute stent malapposition. Follow-up OCT examinations were performed 175±60 days after drug-eluting stent implantation. Thirty-one percent of lesions with acute stent malapposition remained malapposed (late-persistent stent malapposition) and were typically (72%) located within the edges of the stent. The location within the stent edges and the volume of acute stent malapposition were independent predictors of late-persistent stent malapposition. Acute stent malapposition with a volume >2.56 mm(3) differentiated late-persistent stent malapposition from resolved acute stent malapposition. Late-acquired stent malapposition was detected in 15% of all lesions and was usually (61%) located within the stent body. Late-acquired stent malapposition was more frequently associated with plaque/thrombus prolapse on poststent OCT images (70% versus 42%; P<0.001). Clinical events, including cardiovascular death, nonfatal myocardial infarction, and stent thrombosis, did not occur in patients with late stent malapposition during the follow-up period of 28.6±10.3 months after drug-eluting stent implantation.
  
  
  CONCLUSIONS
  Acute, late-persistent, and late-acquired stent malapposition had relatively high incidences but different predictors. The clinical outcome of stent malapposition was favorable.
authors.affiliation: From the Division of Cardiology, Severance Cardiovascular Hospital (E.I., B.-K.K., Y.-G.K., D.-H.S., J.-S.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eui
authors.initials: E
authors.lastname: Im
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000601:surgery; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011475:Prosthesis Failure / Q000209:etiology; D019919:Prosthesis Implantation; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D061205:Vascular Calcification
chemical_list: D015415:Biomarkers
keywords: coronary disease; drug-eluting stents; tomography, optical coherence