Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis.
OBJECTIVE
The intermediate-term incidence of strut malapposition (SM) and uncovered struts (US), and the degree of neointimal thickness (NIT) according to stent type have not been characterized.


RESULTS
All studies of >50 patients in which optical coherence tomography was performed between 6 and 12 months after stent implantation were included. The incidences of SM and US were the co-primary end points, while NIT was the secondary end point. A total of 458 citations were initially appraised at the abstract level, and 11 full-text studies (280 652 analysed struts, 921 patients) were assessed. The 6-12 months incidences of SM and US were 5.0 and 7.8%, respectively, and the mean NIT was 206 μm. Biolimus-eluting stents (BES) and bioresorbable vascular scaffolds (BVS) had the highest SM rates (2.7 and 3.8%, respectively), while everolimus-eluting stents (EES) and fast-release zotarolimus-eluting stents (ZES) had the lowest SM rates (0.9 and 0.1%, respectively). BES and sirolimus-eluting stents (SES) had the highest US rates (7.7 and 8.8%, respectively), while bare metal stents (BMS) and ZES had the lowest US rates (0.3 and 0.3%, respectively). BMS had the greatest NIT (340 μm), while SES, EES, and BES had the least NIT.


CONCLUSIONS
Second-generation drug-eluting stents (DES) have better intermediate-term strut apposition and coverage than first-generation DES, BVS, and BMS. EES demonstrate the overall best combination of healing with suppression of neointimal hyperplasia at 6-12 months. Further studies with clinical correlation are warranted to determine the implications of these findings.
Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy mario.iannaccone@hotmail.it.
Mario
M
Iannaccone
Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy.
Fabrizio
F
D'Ascenzo
University Heart Center, Cardiology, University Hospital, Zurich, Switzerland.
Christian
C
Templin
Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy.
Pierluigi
P
Omedè
Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy.
Antonio
A
Montefusco
Cardiovascular Department, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Giulio
G
Guagliumi
Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands.
Patrick W
PW
Serruys
National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
Carlo
C
Di Mario
Department of Cardiology, Warsaw Medical University, Warszawa, Poland.
Janusz
J
Kochman
Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy.
Giorgio
G
Quadri
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
Giuseppe
G
Biondi-Zoccai
University Heart Center, Cardiology, University Hospital, Zurich, Switzerland.
Thomas F
TF
Lüscher
Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy.
Claudio
C
Moretti
Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy.
Maurizio
M
D'amico
Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy.
Fiorenzo
F
Gaita
Division of Cardiology, Columbia University Medical Center, New York, NY, USA.
Gregg W
GW
Stone
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
BV; EES; OCT; drug-eluting stent; neointima thickness; optical coherence tomograph; strut malapposition; strut uncoverage