Key result
SES linked to ~28% strut malapposition in STEMI, higher than PES or ZES.
Why the study?
The extent of initial malapposition in STEMI patients treated with different types of drug-eluting stents using OCT was not well characterized.
Does the type of drug-eluting stent affect the incidence of initial stent malapposition measured by OCT in STEMI patients undergoing primary PCI?
Observational (n=24)
No
Does the type of drug-eluting stent affect the incidence of initial stent malapposition measured by OCT in STEMI patients undergoing primary PCI?
OCT reveals a high prevalence of initial stent malapposition in STEMI patients treated with primary PCI, particularly with sirolimus-eluting stents, highlighting the utility of high-resolution imaging for evaluating stent deployment.
Answers are grounded in this paper and cite their sources.
Sirolimus-eluting stents linked to higher malapposition in STEMI; leaves open whether stent choice or OCT guidance improves outcomes.
PURPOSE: The aim of this study is to identify the extent of initial malapposition using optical coherence tomography (OCT) in ST-elevation myocardial infarctions (STEMI) treated with different types of drug-eluting stents (DES). MATERIALS AND METHODS: Twenty four STEMI patients that underwent primary percutaneous coronary intervention (PCI) were enrolled. The OCT and intravascular ultrasound (IVUS) were performed within 72 hours after the primary PCI. Distances between the endo-luminal surface of the strut reflection and the vessel wall and the extent of malapposition were measured and analyzed. RESULTS: Sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES) and zotarolimus-eluting stents (ZES) were deployed in 7 patients (29%), 7 patients (29%) and 10 patients (42%). In total, 4951 struts in 620 mm single-stent segments were analyzed (1463 struts in SES, 1522 in PES, and 1966 in ZES). In strut analysis by OCT, the incidence of malapposition was 17 % (860/4951) and in stent analysis by IVUS, malapposition rate was 21% (5/24). The malapposition rate of strut level using OCT in 5 patients who had malapposition in IVUS was significantly higher than the 19 of those who had not (32 +/- 5% vs. 12 +/- 6%, p = 0.001). In addition, the frequency of malapposition was also significantly different (28% in SES, 11% in PES, 10% in ZES, p = 0.001). The use of SES was an independent predictor of malapposed struts. CONCLUSION: The incidence of malapposition using OCT was quite prevalent in STEMI after primary PCI with DES implantation and SES has especially higher rates of malapposition compared to other DESs.
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Kim et al. (2010) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=24). Sirolimus-eluting stents (SES) vs. Paclitaxel-eluting stents (PES) and Zotarolimus-eluting stents (ZES) was evaluated on Incidence of stent strut malapposition measured by optical coherence tomography (p=0.001). Sirolimus-eluting stents demonstrated a significantly higher rate of strut malapposition (28%) compared to paclitaxel-eluting (11%) and zotarolimus-eluting stents (10%) in STEMI patients.
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