Interventional Cardiology, San Giovanni Hospital, Rome, Italy.
Heart. 2011 Nov;97(22):1841-6. doi: 10.1136/heartjnl-2011-300782. Epub 2011 Aug 31.
Lack of stent coverage appears to be associated with stent thrombosis, a problem of particular concern in patients with ST elevation myocardial infarction (STEMI).
The DETECTIVE European Multicenter Registry was set up to address the early modality of stent healing in the setting of STEMI. The Registry compared, with an early optical coherence tomography (OCT) evaluation performed at 3-7 days, the patterns of coverage and apposition of the first generation of drug-eluting stents (DESs) and cobalt chromium non-drug-eluting stents (CCSs) that were deployed in culprit lesions and in non-culprit segments. The Registry included only patients with a multi-vessel disease to allow, at 3-7 days from the first angioplasty, a deferred OCT examination and a staged intervention in another vessel.
28 stented lesions (15 patients) eventually entered the final OCT assessment. 13 stents were first-generation DESs, while the remaining 15 were CCSs. 18 stents (64%) were deployed at culprit STEMI lesions, and the remaining 10 (36%) were deployed at non-culprit sites. The distribution of clinical and procedural variables in DES and CCS as well as in culprit and non-culprit sites was not different. In total, 27,019 struts were analysed in 28 stents. The percentage of stent uncoverage in the overall analysis was 11.7%, while the percentage of malapposition and that of struts covered with thrombus were 4.8% and 2.2%, respectively. A low percentage of strut uncoverage was found in all the four studied subgroups: DES 12.8%, CCS 10.9%, stents deployed in culprit lesions 13.2% and stents deployed in non-culprit lesions 8.7%.
In conclusion, our data show that in patients with STEMI, a very high percentage of stent struts is covered by an early thin rim of tissue within 7 days after stent positioning. The present data bring new insights in the mechanism and timing of strut coverage.
支架覆盖不足似乎与支架血栓形成有关，这是 ST 段抬高型心肌梗死（STEMI）患者特别关注的问题。
DETECTIVE 欧洲多中心注册研究旨在解决 STEMI 情况下早期支架愈合方式的问题。该注册研究通过 3-7 天的早期光学相干断层扫描（OCT）评估，比较了第一代药物洗脱支架（DES）和钴铬非药物洗脱支架（CCS）在罪犯病变和非罪犯病变节段的覆盖和贴壁模式。该注册研究仅纳入多血管疾病患者，以便在首次血管成形术后 3-7 天进行延迟 OCT 检查和另一血管的分期介入。
28 个支架病变（15 例患者）最终进入最终 OCT 评估。13 个支架为第一代 DES，其余 15 个为 CCS。18 个支架（64%）植入罪犯 STEMI 病变，其余 10 个支架（36%）植入非罪犯病变。DES 和 CCS 以及罪犯和非罪犯部位的临床和手术变量分布无差异。共分析了 28 个支架中的 27019 个支架。整体分析中支架覆盖不足的比例为 11.7%，贴壁不良和血栓覆盖的支架比例分别为 4.8%和 2.2%。在所有四个研究亚组中，支架覆盖率均较低：DES 为 12.8%，CCS 为 10.9%，罪犯病变植入支架为 13.2%，非罪犯病变植入支架为 8.7%。
总之，我们的数据表明，在 STEMI 患者中，支架内有很大比例的支架梁在支架放置后 7 天内被一层薄薄的组织覆盖。目前的数据为支架覆盖的机制和时间提供了新的见解。
