title: Role of residual acute stent malapposition in percutaneous coronary interventions.
abstract: OBJECTIVE
  Assess clinical consequences of acute stent malapposition (ASM) in the context of the multicenter Centro per la Lotta Contro l'Infarto-Optimization of Percutaneous Coronary Intervention (CLI-OPCI) registry.
  
  
  BACKGROUND
  ASM as important determinant of stent thrombosis (ST) risk remains controversial.
  
  
  METHODS
  From 2009 to 2013, we retrospectively analyzed postprocedural optical coherence tomography (OCT) findings in 864 patients undergoing percutaneous coronary intervention, assessing prevalence and magnitude of ASM and exploring correlation with outcome, especially ST.
  
  
  RESULTS
  Postprocedural OCT revealed a variable grade of ASM in 72.3% of stents without correlation between maximal strut-vessel distance and longitudinal extension (R = 0.164, P < 0.01). At a median follow up of 302 (IQ 127-567) days, ASM did not affect risk of following major cardiac adverse events (MACE); residual ASM was comparable in terms of thickness (median [quartiles] 0.21[IQ 0.1-0.4] vs. 0.20[IQ 0.0-0.3], P = 0.397) and length (2.0[IQ 0.5-4.1] vs. 2.2[IQ 0.0-5.2], P = 0.640) in patients with versus without MACE. The predictive accuracy for outcome was low (C-statistic 0.52, CI 95% 0.47-0.58, P = 0.394) as well for target lesion revascularization (HR 0.80, CI 95% 0.5-1.4) and ST (HR 0.71, CI 95% 0.3-1.5). Likewise, timing to MACE was not influenced by presence of such an ASM with similar rate of acute-subacute (HR 1.09, CI 95% 0.6-1.9), late (HR 0.91, CI 95% 0.5-1.8), and very late (HR 1.23, CI 95% 0.5-2.9) events.
  
  
  CONCLUSIONS
  Limited ASM was a common finding after stent implantation, but was not associated to increased risk of stent failure or ST during mid-term follow-up. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.
authors.forename: Enrico
authors.identifier: http://orcid.org/0000-0003-1611-7708
authors.initials: E
authors.lastname: Romagnoli
authors.affiliation: Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.|San Giovanni Addolorata Hospital, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Gatto
authors.affiliation: Division of Cardiology, University of Catania, Catania, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.affiliation: Università Cattolica Del Sacro Cuore, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.affiliation: Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.affiliation: Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
authors.forename: Francesco
authors.identifier: http://orcid.org/0000-0001-9969-2649
authors.initials: F
authors.lastname: Saia
authors.affiliation: Presidio Ospedaliero Sant'Elia, Caltanissetta, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Amico
authors.affiliation: Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Marco
authors.affiliation: San Giovanni Addolorata Hospital, Rome, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Ramazzotti
authors.affiliation: Policlinico G. Martino, Messina, Sicily, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Giorgio
authors.affiliation: San Giovanni Addolorata Hospital, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.affiliation: Ospedale Brotzu, Cagliari, Sardinia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Boi
authors.affiliation: Presidio Ospedaliero Umberto I, Siracusa, Sicily, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Contarini
authors.affiliation: GVM Care and Research, E. S. Health Science Foundation, Cotignola, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.|San Giovanni Addolorata Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D015995:Prevalence; D011475:Prosthesis Failure; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: optical coherence tomography; percutaneous coronary intervention; registry; stent malapposition