BACKGROUND: Predictors and long-term prognosis of late stent malapposition (LSM) after bare-metal stent (BMS) implantation are unknown. METHODS AND RESULTS: We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after BMS implantation in 881 patients (992 native lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM was defined as a separation of stent struts from the intimal surface of the arterial wall that was not presented at stent implantation. LSM occurred in 54 patients with 54 lesions (5.4% overall); the incidence was 10.3% (9 of 87) after directional coronary atherectomy (DCA) before stenting and 11.5% (11 of 96) after primary stenting in acute myocardial infarction (P=0.031 and P=0.007, respectively, versus elective stenting with conventional balloon pre-dilation, 4.3% [30 of 692]). There was an increase of external elastic membrane area (18.9+/-3.9 to 24.5+/-5.1 mm2, P<0.001) that was greater than the increase in plaque area (9.6+/-3.0 to 11.4+/-2.9 mm2, P<0.001). Independent predictors of LSM were primary stenting in acute myocardial infarction (P=0.023, OR=2.55, 95% CI=1.14 to 5.69) and DCA before stenting (P=0.025, OR=3.02, 95% CI=1.15 to 7.96). There were no significant differences in major adverse cardiac events between LSM and non-LSM groups during mean 3-year follow-up (1.9% versus 1.8%, respectively, P=NS). CONCLUSIONS: LSM occurs in approximately 5% after BMS implantation. The predictors of LSM are primary stenting in acute myocardial infarction and DCA before stenting. Compared with complete stent apposition at follow-up, LSM after BMS implantation is not associated with any major adverse cardiac events during a mean 3-year follow-up after detection of LSM.
BACKGROUND: Predictors and long-term prognosis of late stent malapposition (LSM) after bare-metal stent (BMS) implantation are unknown. METHODS AND RESULTS: We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after BMS implantation in 881 patients (992 native lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM was defined as a separation of stent struts from the intimal surface of the arterial wall that was not presented at stent implantation. LSM occurred in 54 patients with 54 lesions (5.4% overall); the incidence was 10.3% (9 of 87) after directional coronary atherectomy (DCA) before stenting and 11.5% (11 of 96) after primary stenting in acute myocardial infarction (P=0.031 and P=0.007, respectively, versus elective stenting with conventional balloon pre-dilation, 4.3% [30 of 692]). There was an increase of external elastic membrane area (18.9+/-3.9 to 24.5+/-5.1 mm2, P<0.001) that was greater than the increase in plaque area (9.6+/-3.0 to 11.4+/-2.9 mm2, P<0.001). Independent predictors of LSM were primary stenting in acute myocardial infarction (P=0.023, OR=2.55, 95% CI=1.14 to 5.69) and DCA before stenting (P=0.025, OR=3.02, 95% CI=1.15 to 7.96). There were no significant differences in major adverse cardiac events between LSM and non-LSM groups during mean 3-year follow-up (1.9% versus 1.8%, respectively, P=NS). CONCLUSIONS: LSM occurs in approximately 5% after BMS implantation. The predictors of LSM are primary stenting in acute myocardial infarction and DCA before stenting. Compared with complete stent apposition at follow-up, LSM after BMS implantation is not associated with any major adverse cardiac events during a mean 3-year follow-up after detection of LSM.
Authors: Michail I Papafaklis; Christos S Katsouras; Panagiotis E Theodorakis; Christos V Bourantas; Dimitrios I Fotiadis; Lampros K Michalis Journal: Heart Vessels Date: 2007-07-20 Impact factor: 2.037
Authors: G J Ughi; T Adriaenssens; K Onsea; P Kayaert; C Dubois; P Sinnaeve; M Coosemans; W Desmet; J D'hooge Journal: Int J Cardiovasc Imaging Date: 2011-02-24 Impact factor: 2.357
Authors: Ajay Yadlapati; Mark Gajjar; Daniel R Schimmel; Mark J Ricciardi; James D Flaherty Journal: Intern Emerg Med Date: 2016-10-06 Impact factor: 3.397