title: Optical coherence tomography follow-up 18 months after titanium-nitride-oxide-coated versus everolimus-eluting stent implantation in patients with acute coronary syndrome.
abstract: Background Inadequate neointimal coverage of stent struts is associated with late stent thrombosis. Purpose To demonstrate the extent of neointimal coverage and strut malapposition in titanium-nitride-oxide-coated bioactive stents (BAS) versus everolimus-eluting stents (EES) by optical coherence tomography (OCT) performed at 18-month follow-up. Material and Methods In the BASE-ACS trial, 827 patients presenting with acute coronary syndrome were randomized to receive either BAS or EES. Forty patients (20 BAS, 20 EES) underwent OCT at 18-month follow-up for evaluation of stent strut coverage, malapposition, and neointimal hyperplasia (NIH). Primary endpoint was binary stent strut coverage (ratio of covered struts to all analyzed struts multiplied by 100). Co-primary endpoint was the percentage of malapposed struts. Results We analyzed 3465 struts in 330 cross-sections of BAS and 3327 struts in 316 cross-sections of EES. Binary stent strut coverage, based on strut-level analysis, was higher with BAS versus EES (99.5% versus 94.2%, respectively; P < 0.001), the strut-level percentage of malapposed struts was lower with BAS (0.6% versus 2.5%, respectively; P < 0.001). Yet, the mean NIH thickness was greater with BAS (237 ± 125 versus 108 ± 62 µm, respectively; P < 0.001). Conclusion In the current post-hoc analysis with OCT performed at 18 months, binary strut coverage, based on strut-level analysis, was higher with BAS versus EES; strut-level malapposed struts were fewer with BAS; yet, BAS induced thicker NIH.
authors.affiliation: 1 Heart Center, Satakunta Central Hospital, Pori, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Karjalainen
authors.affiliation: 1 Heart Center, Satakunta Central Hospital, Pori, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Paana
authors.affiliation: 1 Heart Center, Satakunta Central Hospital, Pori, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Ylitalo
authors.affiliation: 2 Heart Center, Kokkola Central Hospital, Kokkola, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Sia
authors.affiliation: 1 Heart Center, Satakunta Central Hospital, Pori, Finland.
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D020099:Coated Materials, Biocompatible; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D058426:Neointima; D014025:Titanium; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; C434243:titanium-nitride-oxide; D000068338:Everolimus; D014025:Titanium
keywords: Optical coherence tomography; drug-eluting stents; neointimal coverage; strut malapposition; titanium-nitride-oxide-coated stents