title: Impact of Culprit Plaque and Atherothrombotic Components on Incomplete Stent Apposition in Patients With ST-Elevation Myocardial Infarction Treated With Everolimus-Eluting Stents　- An OCTAVIA Substudy.
abstract: BACKGROUND
  The role of culprit plaque and related atherothrombotic components on incomplete stent apposition (ISA) occurrence after primary percutaneous coronary intervention (p-PCI) is unknown.
  
  
  RESULTS
  ST-segment elevation myocardial infarction (STEMI) patients undergoing p-PCI with an everolimus-eluting stent were prospectively investigated with optical coherence tomography (OCT) of the infarct-related artery before, after stenting and at 9 months. OCT data, aspirated thrombus and serum inflammatory biomarkers were analyzed. 114 patients with 114 lesions were evaluated. Acute ISA occurred in 82 lesions (71.9%), preferentially in larger vessels with a median area of 0.2 mm(2). The presence of thrombus before stent implantation (odds ratio (OR) 5.5, 95% confidence interval (CI) [1.1-26.9], P=0.04) and the lipid content in the target segment (OR 1.3, 95% CI [1.0-1.5], P=0.04) independently predicted acute ISA. At 9-month follow-up, ISA persisted in 46 lesions (56.1%). The volume of acute ISA significantly predicted persistent ISA (OR 1.3, 95% CI [1.1-1.5], P=0.01). Late-acquired ISA occurred in 39 lesions (34.2%) with a median area of 0.3 mm(2). Red/mixed thrombus before stent implantation (OR 3.7, 95% CI [1.0-13.3], P=0.05) and length of the underlying ruptured plaque (OR 1.7, 95% CI [1.1-2.8] P=0.02) were independently associated with late-acquired ISA.
  
  
  CONCLUSIONS
  In STEMI patients, culprit plaque and atherothrombotic components of the infarct-related artery significantly contribute to the onset of acute and late ISA. ISA persistence at follow-up depends on the initial volume of acute ISA.
authors: Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII.
authors: Chiara
authors: C
authors: Bernelli
authors: Kunihiro
authors: K
authors: Shimamura
authors: Kenichi
authors: K
authors: Komukai
authors: Davide
authors: D
authors: Capodanno
authors: Francesco
authors: F
authors: Saia
authors: Roberto
authors: R
authors: Garbo
authors: Francesco
authors: F
authors: Burzotta
authors: Vasile
authors: V
authors: Sirbu
authors: Micol
authors: M
authors: Coccato
authors: Gianluca
authors: G
authors: Campo
authors: Luigi
authors: L
authors: Vignali
authors: Hirosada
authors: H
authors: Yamamoto
authors: Giampaolo
authors: G
authors: Niccoli
authors: Elena
authors: E
authors: Ladich
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Giulio
authors: G
authors: Guagliumi
mesh_terms: D000368:Aged; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000601:surgery*; D013927:Thrombosis / Q000601:surgery*
chemical_list: D000068338:Everolimus