Late stent malapposition after bare-metal stent implantation was not associated with an increase in major adverse cardiac events compared to complete apposition at 3 years (1.9% vs 1.8%, P=NS).
Cohort (n=881)
Does late stent malapposition after bare-metal stent implantation increase the risk of major adverse cardiac events?
Late stent malapposition occurs in approximately 5% of patients after bare-metal stent implantation and is predicted by primary stenting in acute myocardial infarction and directional coronary atherectomy, but it is not associated with an increased risk of major adverse cardiac events at 3 years.
Absolute Event Rate: 1.9% vs 1.8%
p-value: p=NS
BACKGROUND: Predictors and long-term prognosis of late stent malapposition (LSM) after bare-metal stent (BMS) implantation are unknown. METHODS AND RESULTS: We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after BMS implantation in 881 patients (992 native lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM was defined as a separation of stent struts from the intimal surface of the arterial wall that was not presented at stent implantation. LSM occurred in 54 patients with 54 lesions (5.4% overall); the incidence was 10.3% (9 of 87) after directional coronary atherectomy (DCA) before stenting and 11.5% (11 of 96) after primary stenting in acute myocardial infarction (P=0.031 and P=0.007, respectively, versus elective stenting with conventional balloon pre-dilation, 4.3% 30 of 692). There was an increase of external elastic membrane area (18.9+/-3.9 to 24.5+/-5.1 mm2, P<0.001) that was greater than the increase in plaque area (9.6+/-3.0 to 11.4+/-2.9 mm2, P<0.001). Independent predictors of LSM were primary stenting in acute myocardial infarction (P=0.023, OR=2.55, 95% CI=1.14 to 5.69) and DCA before stenting (P=0.025, OR=3.02, 95% CI=1.15 to 7.96). There were no significant differences in major adverse cardiac events between LSM and non-LSM groups during mean 3-year follow-up (1.9% versus 1.8%, respectively, P=NS). CONCLUSIONS: LSM occurs in approximately 5% after BMS implantation. The predictors of LSM are primary stenting in acute myocardial infarction and DCA before stenting. Compared with complete stent apposition at follow-up, LSM after BMS implantation is not associated with any major adverse cardiac events during a mean 3-year follow-up after detection of LSM.
Hong et al. (Tue,) conducted a cohort in Bare-metal stent implantation (n=881). Late stent malapposition vs. Complete stent apposition (non-LSM) was evaluated on Major adverse cardiac events (p=NS). Late stent malapposition after bare-metal stent implantation was not associated with an increase in major adverse cardiac events compared to complete apposition at 3 years (1.9% vs 1.8%, P=NS).