Key result
Subclinical intrastent thrombus detected by coronary angioscopy 9 months after 2nd-generation DES implantation was independently associated with MACE (adjusted HR 2.22; 95% CI 1.12-4.39).
Why the study?
Does the presence of subclinical intrastent thrombus detected by coronary angioscopy 9 months after 2nd-generation DES implantation predict future major adverse cardiac events in patients with coronary artery disease?
Cohort (n=179)
Does the presence of subclinical intrastent thrombus detected by coronary angioscopy 9 months after 2nd-generation DES implantation predict future major adverse cardiac events in patients with coronary artery disease?
Answers are grounded in this paper and cite their sources.
Subclinical intrastent thrombus detected by coronary angioscopy 9 months after 2nd-generation DES implantation is an independent predictor of future major adverse cardiac events.
BACKGROUND: Detection of yellow plaques (YP) by coronary angioscopy (CAS) 1 year after 1st-generation drug-eluting stent (DES) implantation has been related to future coronary events. However, the association between CAS findings and clinical outcomes following 2nd-generation DES implantation has not been investigated. METHODS AND RESULTS: This study included a total of 248 2nd-generation DES in 179 patients, who were examined by CAS 9±2 months after implantation. Angioscopic evaluation included dominant neointimal coverage (NIC) grade, heterogeneity of NIC, presences of YP and intrastent thrombus. The outcome measure was major adverse cardiac events (MACE) defined as a composite of cardiac death, acute myocardial infarction and any coronary revascularization. The association between the CAS findings and MACE was evaluated using the Kaplan-Meier method. A Cox proportional hazards model was used to assess the predictors of MACE. The mean follow-up duration was 1,367±843 days. Dominant NIC grade (P=0.98), heterogeneity of NIC (P=0.20) and YP (P=0.53) were not associated with the incidence of MACE. However, intrastent thrombus was significantly associated with MACE (P=0.033). Intrastent thrombus (adjusted hazard ratio: 2.22; 95% confidence interval [CI]: 1.12-4.39), acute coronary syndrome (2.83; 95% CI: 1.42-5.67) and B2/C lesion (2.13; CI: 1.12-4.05) were independent predictors of MACE. CONCLUSIONS: Subclinical intrastent thrombus observed by CAS at 9 months after 2nd-generation DES implantation was independently associated with poor clinical outcome.
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Okuno et al. (2018) conducted a cohort in 2nd-generation drug-eluting stent implantation (n=179). Subclinical intrastent thrombus detected by coronary angioscopy vs. Absence of intrastent thrombus was evaluated on Major adverse cardiac events (MACE) defined as a composite of cardiac death, acute myocardial infarction and any coronary revascularization (adjusted HR 2.22, 95% CI 1.12-4.39, p=0.033). Subclinical intrastent thrombus detected by coronary angioscopy 9 months after 2nd-generation DES implantation was independently associated with MACE (adjusted HR 2.22; 95% CI 1.12-4.39).
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