Tae-Min Rhee1, Kyung Woo Park2, Joo Myung Lee1, Michael S Lee1, Ki-Hyun Jeon1, Hyun-Jae Kang1, Bon-Kwon Koo1, Jay Young Rhew1, Kwang Soo Cha1, Jang-Ho Bae1, Kyoo-Rok Han1, Si-Hoon Park1, Woo-Jung Park1, Seung-Woon Rha1, Seok-Kyu Oh1, Hyuck Moon Kwon1, Ki-Bae Seung1, Taehoon Ahn1, Sang-Hyun Kim1, Hyo-Soo Kim1. 1. From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea (J.Y.R.); Department of Internal Medicine, Busan National University Hospital, Republic of Korea (K.S.C.); Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea (J.-H.B.); Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea (K.-R.H.); Department of Internal Medicine, Ewha Woman's University Mokdong Hospital, Seoul, Republic of Korea (S.-H.P.); Department of Internal Medicine, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea (W.-J.P); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea (S.-W.R.); Department of Internal Medicine, Wonkwang University Hospital, Iksan, Republic of Korea (S.-K.O.); Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (H.M.K.); Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea (K.-B.S.); Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea (T.A.); and Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea (S.-H.K.). 2. From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea (J.Y.R.); Department of Internal Medicine, Busan National University Hospital, Republic of Korea (K.S.C.); Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea (J.-H.B.); Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea (K.-R.H.); Department of Internal Medicine, Ewha Woman's University Mokdong Hospital, Seoul, Republic of Korea (S.-H.P.); Department of Internal Medicine, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea (W.-J.P); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea (S.-W.R.); Department of Internal Medicine, Wonkwang University Hospital, Iksan, Republic of Korea (S.-K.O.); Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (H.M.K.); Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea (K.-B.S.); Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea (T.A.); and Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea (S.-H.K.). kwparkmd@snu.ac.kr.
Abstract
BACKGROUND: There are limited data on the frequency of and factors associated with quantitative coronary angiography (QCA)-defined longitudinal stent deformation (LSD) in various contemporary drug-eluting stents platforms. This study sought to evaluate the predictors of LSD and its long-term clinical implication. METHODS AND RESULTS: A patient-level pooled analysis was performed with 7350 lesions in 5871 patients treated with platinum-chromium-based everolimus-eluting stent (Promus Element), cobalt-chromium-based everolimus-eluting stent (Promus/Xience V), or cobalt-chromium-based zotarolimus-eluting stent (Endeavor Resolute). QCA was performed to analyze differences of stent length between immediate post-deployment and final post-procedure. Independent factors associated with LSD were identified. Clinical outcomes at 3 years were compared between those with and without QCA-based LSD. The frequency of QCA-based LSD was 1.12% (82 cases). Nine of these cases were angiographically overt. Left main or ostial lesion, bifurcation treatment with provisional side branch stenting or ballooning, additional downstream intervention of a distal lesion, intravascular ultrasound use, and adjunctive post-dilatation were independently associated with QCA-based LSD. The type of stent was not associated with QCA-based LSD. Rates of target lesion failure were nominally higher in lesions with QCA-based LSD than in those without (8.97% versus 5.88%; hazard ratio, 1.415; 95% confidence interval, 0.631-3.175; P=0.399). CONCLUSIONS: LSD is uncommon with contemporary drug-eluting stents, regardless of the type of stent platform. LSD is mainly associated with procedural factors, especially with additional downstream procedures which require the passage of devices through the stent. Careful manipulation of poststent imaging or procedural devices is required to prevent LSD. More data are needed to clarify the impact of LSD on clinical events.
BACKGROUND: There are limited data on the frequency of and factors associated with quantitative coronary angiography (QCA)-defined longitudinal stent deformation (LSD) in various contemporary drug-eluting stents platforms. This study sought to evaluate the predictors of LSD and its long-term clinical implication. METHODS AND RESULTS: A patient-level pooled analysis was performed with 7350 lesions in 5871 patients treated with platinum-chromium-based everolimus-eluting stent (Promus Element), cobalt-chromium-based everolimus-eluting stent (Promus/Xience V), or cobalt-chromium-based zotarolimus-eluting stent (Endeavor Resolute). QCA was performed to analyze differences of stent length between immediate post-deployment and final post-procedure. Independent factors associated with LSD were identified. Clinical outcomes at 3 years were compared between those with and without QCA-based LSD. The frequency of QCA-based LSD was 1.12% (82 cases). Nine of these cases were angiographically overt. Left main or ostial lesion, bifurcation treatment with provisional side branch stenting or ballooning, additional downstream intervention of a distal lesion, intravascular ultrasound use, and adjunctive post-dilatation were independently associated with QCA-based LSD. The type of stent was not associated with QCA-based LSD. Rates of target lesion failure were nominally higher in lesions with QCA-based LSD than in those without (8.97% versus 5.88%; hazard ratio, 1.415; 95% confidence interval, 0.631-3.175; P=0.399). CONCLUSIONS: LSD is uncommon with contemporary drug-eluting stents, regardless of the type of stent platform. LSD is mainly associated with procedural factors, especially with additional downstream procedures which require the passage of devices through the stent. Careful manipulation of poststent imaging or procedural devices is required to prevent LSD. More data are needed to clarify the impact of LSD on clinical events.