title: Five-Year Optical Coherence Tomography in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Bare-Metal Versus Everolimus-Eluting Stents.
abstract: The main causes of late (>1 month) stent thrombosis (ST) are stent uncoverage, malapposition, and neoatherosclerosis. First-generation drug-eluting stents were associated with higher rate of late ST compared with bare-metal stents (BMS), especially in patients with ST-segment-elevation myocardial infarction. Second-generation everolimus-eluting stents (EES) have shown similar rate of late ST than BMS. The aims of the study are to compare the ratio of uncovered to total struts per cross-section ≥30% and other optical coherence tomographic findings associated with ST between EES and BMS in patients with ST-segment-elevation myocardial infarction at 5 years.
  
  
  
  One hundred and sixty-nine consecutive event-free patients of the randomized EXAMINATION study (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) were screened for optical coherence tomographic imaging at 5 years. Patients with target vessel-related events or life-threatening comorbidities were excluded. Finally, 64 patients (32 EES and 32 BMS) underwent optical coherence tomographic imaging. At 5 years, uncovered struts (4.1% versus 1.0%; P<0.01), length of uncoverage (3.4 versus 1.4 mm; P=0.02), and ratio of uncovered to total struts per cross-section ≥30% (35.5% versus 9.7%; P=0.02) were larger with EES than that with BMS. Malapposed struts (1.2% versus 0.3%; P=0.02) and malapposition length (1.3 versus 0.4 mm; P=0.06) were also larger with EES. Neoatherosclerotic plaques (16.1% versus 25.8%; P=0.35) and macrophage accumulations (19.4% versus 48.4%; P=0.02) were numerically more frequent with BMS.
  
  
  
  Despite substantial dropout of patients, the healing pattern in event-free ST-segment-elevation myocardial infarction patients differs between EES and BMS at 5 years. EES presented with larger amount of uncovered and malapposed struts and similar rate of neoatherosclerosis as compared with BMS. The clinical relevance of these findings warrants longer follow-up.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00828087.
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.). gomezjosep@hotmail.com.
authors.forename: Josep
authors.initials: J
authors.lastname: Gomez-Lara
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Francisco
authors.initials: F
authors.lastname: Jacobi
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Luis
authors.initials: L
authors.lastname: Ortega-Paz
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Marcos
authors.initials: M
authors.lastname: Ñato
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Ferreiro
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Luis
authors.initials: L
authors.lastname: Teruel
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Montserrat
authors.initials: M
authors.lastname: Gracida
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Victoria
authors.initials: V
authors.lastname: Martin-Yuste
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Monica
authors.initials: M
authors.lastname: Masotti
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Joan-Antoni
authors.initials: JA
authors.lastname: Gomez-Hospital
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
authors.affiliation: From the Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.).
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D058426:Neointima; D010352:Patient Dropouts; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: drug-eluting stents; everolimus; incidence; myocardial infarction; optical coherence tomography