Key result
Acute and persistent stent malapposition after PCI was not significantly associated with the device-oriented composite endpoint (RR 1.00; 95% CI 0.79-1.26; P=0.99).
Why the study?
The association between coronary stent malapposition and adverse clinical outcomes after PCI remains unclear.
Does acute and persistent stent malapposition increase the risk of adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=6,497)
Does acute and persistent stent malapposition increase the risk of adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention?
Relative Risk: 1 (95% CI 0.79–1.26)
p-value: p=0.99
While overall stent malapposition does not significantly worsen clinical outcomes, major malapposition is associated with a nearly 3-fold increased risk of major safety events, highlighting the need for PCI optimization.
Major malapposition warrants imaging-guided optimization during PCI; extends observational evidence linking it to higher cardiac death, MI, and ST risk.
INTRODUCTION: The association of coronary stent malapposition (SM) and adverse clinical outcomes after percutaneous coronary intervention (PCI) remains unclear. We aimed to perform a systematic review and meta-analysis of randomized and observational studies to assess the association between acute and persistent SM detected using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) and adverse cardiovascular outcomes. EVIDENCE ACQUISITION: Available studies were identified through a systematic search of PubMed, reference lists of relevant articles, and Medline. Main efficacy outcomes of interest were: device-oriented composite endpoint (DoCE, including cardiac death, myocardial infarction [MI], target lesion revascularization [TLR], and stent thrombosis [ST]), major safety events (MSE, including cardiac death, MI and ST), TLR, and ST. A sensitivity analysis regarding the impact of major malapposition was also performed. EVIDENCE SYNTHESIS: A total of 9 studies enrolling 6497 patients were included in the meta-analysis. After a mean follow-up of 24±14 months, overall acute and/or persistent malapposition was not significantly associated with the occurrence of all the outcomes of interest, including DoCE (risk ratio [RR] 1.00, 95% confidence interval [CI, 0.79-1.26], P=0.99), MSE (RR 1.42, 95%CI [0.81-2.50], P=0.22), TLR (RR 0.84, 95%CI [0.59-1.19], P=0.33), and ST (RR 1.16, 95%CI [0.48-2.85], P=0.74). In the sensitivity analysis, we found a significant increase of MSE in patients with major malapposition (RR 2.97, 95%CI [1.51-5.87], P=0.001). CONCLUSIONS: Acute and persistent SM were not overall associated with adverse cardiovascular clinical outcomes at follow-up. However, major malapposition was associated with an increased risk of major safety events, including cardiac death, MI and ST. These findings should be taken into account during stent implantation and PCI optimization.
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Lombardi et al. (2023) conducted a meta-analysis in Percutaneous coronary intervention (PCI) (n=6,497). Acute and persistent stent malapposition vs. No stent malapposition was evaluated on Device-oriented composite endpoint (DoCE, including cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis) (RR 1.00, 95% CI 0.79-1.26, p=0.99). Acute and persistent stent malapposition after PCI was not significantly associated with the device-oriented composite endpoint (RR 1.00; 95% CI 0.79-1.26; P=0.99).
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