Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Eur Heart J. 2012 Jun;33(11):1334-43. doi: 10.1093/eurheartj/ehr484. Epub 2012 Jan 26.
Late acquired incomplete stent apposition (ISA) is more common after drug-eluting stent (DES) than bare metal stent (BMS) implantation and has been associated with vascular hypersensitivity and stent thrombosis (ST). We investigated the impact of incidentally discovered ISA as assessed by intravascular ultrasound (IVUS) 8 months after DES implantation on the long-term clinical outcome.
A total of 194 patients with 221 lesions were prospectively followed through 5 years. At 8 months, IVUS showed evidence of ISA among 37 patients with 39 lesions (18%) (mean ISA(max) 4.7 ± 5.0 mm(2)), whereas no ISA was observed among 157 patients with 182 lesions. Incomplete stent apposition was more prevalent among segments treated with sirolimus-eluting (n = 103) than paclitaxel-eluting stents (n = 118) (27 vs. 9%, P = 0.001). Between IVUS investigation at the 8-month and 5-year follow-up, major adverse cardiac events occurred more frequently in patients with (18.9%, n = 7) than without ISA (7.0%, n = 11) (HR = 2.71, 95% CI: 1.05-6.96, P = 0.031). While there were no differences with respect to death, the rate of myocardial infarction was higher among patients with (13.5%, n = 5) than without ISA (1.9%, n = 3) (HR = 7.53, 95% CI: 1.79-31.6, P = 0.001). Very late ST was more common among patients with than without ISA [Academic Research Consortium-definite ST:13.5% (n = 5) vs. 0.6% (n = 1) HR = 23.2, 95% CI: 2.65-203, P < 0.001].
In the present study, the presence of ISA as assessed by IVUS 8 months after DES implantation was associated with a higher rate of myocardial infarction and very late stent thrombosis during long-term follow-up. The prognostic impact of ISA on long-term clinical outcomes requires further investigation.
药物洗脱支架（DES）置入后迟发不完全支架贴壁（ISA）比裸金属支架（BMS）更为常见，与血管高反应性和支架内血栓形成（ST）有关。我们研究了 DES 置入 8 个月后通过血管内超声（IVUS）偶然发现的 ISA 对长期临床结果的影响。
共前瞻性随访了 194 例患者的 221 处病变，随访时间长达 5 年。8 个月时，IVUS 显示 37 例患者的 39 处病变（18%）存在 ISA（平均 ISA（max）为 4.7±5.0mm2），而 157 例患者的 182 处病变未见 ISA。依维莫司洗脱支架（n=103）治疗的节段比紫杉醇洗脱支架（n=118）更易出现不完全支架贴壁（27%比 9%，P=0.001）。在 IVUS 检查的 8 个月和 5 年随访期间，ISA 组（18.9%，n=7）主要不良心脏事件（MACE）发生率高于无 ISA 组（7.0%，n=11）（HR=2.71，95%CI：1.05-6.96，P=0.031）。虽然两组死亡率无差异，但 ISA 组心肌梗死发生率（13.5%，n=5）高于无 ISA 组（1.9%，n=3）（HR=7.53，95%CI：1.79-31.6，P=0.001）。ISA 组迟发 ST 发生率高于无 ISA 组[学术研究联合会定义的 ST：13.5%（n=5）比 0.6%（n=1），HR=23.2，95%CI：2.65-203，P<0.001]。
本研究中，DES 置入 8 个月后通过 IVUS 评估的 ISA 与长期随访期间更高的心肌梗死和迟发支架血栓形成发生率相关。ISA 对长期临床结局的预后影响需要进一步研究。
