August 31, 2010Circulation
Incidence, Mechanisms, Predictors, and Clinical Impact of Acute and Late Stent Malapposition After Primary Intervention in Patients With Acute Myocardial Infarction
Key result
Paclitaxel-eluting stents had similar acute stent malapposition to bare metal stents (34.3% vs 40.3%) but increased the risk of late acquired malapposition (OR 6.32; 95% CI 2.15-18.62).
Why the study?
Does the use of paclitaxel-eluting stents compared to bare metal stents affect the incidence of acute and late stent malapposition in patients with STEMI?
Population
241 patients with ST-segment elevation myocardial infarction (STEMI) and 263 native coronary lesions
Comparison
Paclitaxel-eluting stents (PES) (n=201 lesions) vs Bare metal stents (BMS) (n=62 lesions)
Design
RCT, dual-arm, factorial, randomized trial
Follow-up
13 months
Authors
Discussion
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Implication
Raises concern for paclitaxel-eluting stent use in STEMI; confirms positive remodeling as driver of late malapposition.
Study Design
Type
RCT (n=241)
Randomization
Factorial
Structured PICO
Does the use of paclitaxel-eluting stents compared to bare metal stents affect the incidence of acute and late stent malapposition in patients with STEMI?
P
Population
241 patients with ST-segment elevation myocardial infarction (STEMI) and 263 native coronary lesions
I
Intervention
Paclitaxel-eluting stents (PES) (n=201 lesions)
C
Comparator
Bare metal stents (BMS) (n=62 lesions)
O
Outcome
Incidence and mechanisms of acute and late stent malapposition assessed by intravascular ultrasoundsurrogate
Main Result
Absolute Event Rate: 34.3% vs 40.3%
In patients with STEMI, paclitaxel-eluting stents are associated with a higher incidence of late acquired stent malapposition compared to bare metal stents, primarily due to positive remodeling and plaque/thrombus resolution.
Cite This Study
Guo et al. (2010) conducted an RCT in ST-segment elevation myocardial infarction (n=241). Paclitaxel-eluting stents (PES) vs. Bare metal stents (BMS) was evaluated on Postintervention acute stent malapposition (ASM). Paclitaxel-eluting stents had similar acute stent malapposition to bare metal stents (34.3% vs 40.3%) but increased the risk of late acquired malapposition (OR 6.32; 95% CI 2.15-18.62).