March 23, 2019Journal of the American Heart AssociationOpen Access

Long‐Term Clinical Outcomes of Late Stent Malapposition Detected by Optical Coherence Tomography After Drug‐Eluting Stent Implantation

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Why the study?

The relationship between late stent malapposition and adverse cardiovascular events is controversial, and studies evaluating long-term (>5 years) clinical outcomes of OCT-detected malapposition after drug-eluting stent implantation are needed.

Does late stent malapposition detected by OCT after drug-eluting stent implantation increase the risk of adverse cardiovascular events?

Structured PICO

Does late stent malapposition detected by OCT after drug-eluting stent implantation increase the risk of adverse cardiovascular events?

Population

351 patients who received drug-eluting stents and were examined by both poststent and follow-up optical coherence tomography (OCT) at 175±60 days after implantation

Intervention

Presence of late stent malapposition (LSM) detected by OCT

Comparator

Absence of late stent malapposition (LSM) detected by OCT

Outcome

Composite of cardiovascular death, target-vessel-related myocardial infarction, target-vessel revascularization, and stent thrombosiscomposite

Late stent malapposition detected by OCT after drug-eluting stent implantation is not associated with an increased risk of long-term adverse clinical events, including very late stent thrombosis.

Implication

LSM after DES shows no link to very late thrombosis or events; leaves open whether OCT surveillance should guide management.

Abstract

Background The relationship between late stent malapposition ( LSM ) and adverse cardiovascular events is controversial. Studies are needed to evaluate long-term (>5 years) clinical outcomes of LSM detected by optical coherence tomography ( OCT ) after drug-eluting stent implantation. Methods and Results We investigated long-term clinical outcomes of OCT -detected LSM in 351 patients who received drug-eluting stents and were examined by both poststent and follow-up OCT (175±60 days after drug-eluting stent implantation) from January 2009 to December 2011. LSM was observed in 99 patients (28%). We evaluated the cumulative rate of composite events (cardiovascular death, target-vessel-related myocardial infarction, target-vessel revascularization, and stent thrombosis). During 80.1±24.5 months of follow-up, very late stent thrombosis did not occur in any patients with LSM . The cumulative 8-year rate of composite events was 7.3% in patients with LSM and 10.5% in patients without LSM ( P=0.822, log-rank test). We further divided patients into the following 4 groups: patients with both late-persistent and late-acquired stent malapposition (n=23), patients with late-persistent stent malapposition alone (n=45), patients with late-acquired stent malapposition alone (n=31), and patients without LSM (n=252). The cumulative 8-year rates of composite events were similar among these 4 groups (0%, 9.6%, 9.7%, and 10.5%, respectively; P=0.468 by log-rank test). Conclusions During long-term follow-up (>5 years), very late stent thrombosis did not occur in patients with OCT -detected LSM . The rates of adverse clinical events were similar between patients with LSM versus those without LSM . Presence of OCT -detected LSM was not associated with unfavorable clinical outcomes.