Wang Bin, Mintz Gary S, Witzenbichler Bernhard, Souza Cristiano F, Metzger D Christopher, Rinaldi Michael J, Duffy Peter L, Weisz Giora, Stuckey Thomas D, Brodie Bruce R, Matsumura Mitsuaki, Yamamoto Myong-Hwa, Parvataneni Rupa, Kirtane Ajay J, Stone Gregg W, Maehara Akiko
Cardiovascular Research Foundation, New York, NY.
Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY.
J Am Heart Assoc. 2016 Dec 22;5(12):e004438. doi: 10.1161/JAHA.116.004438.
The impact of acute stent malapposition (ASM) on long-term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long-term clinical outcomes of ASM.
ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug-eluting stents. In a prespecified intravascular ultrasound-guided substudy, 2072 patients with 2446 culprit lesions had post-percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound-guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug-eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in-stent lumen areas, larger stent areas, and larger in-stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2-year follow-up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2-year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model.
In patients treated with intravascular ultrasound-guided drug-eluting stents implantation, ASM was not associated with adverse clinical events during long-term follow-up including, but not limited to, stent thrombosis.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.
急性支架贴壁不良（ASM）对接受经皮冠状动脉介入治疗患者的长期临床结局的影响仍存在争议。我们旨在评估ASM的预测因素和长期临床结局。
ADAPT-DES（药物洗脱支架双重抗血小板治疗评估）是一项对8663例接受药物洗脱支架经皮冠状动脉介入治疗患者的前瞻性多中心研究。在一项预先指定的血管内超声引导亚研究中，2072例有2446处罪犯病变的患者接受了经皮冠状动脉介入治疗后的血管内超声检查，并根据是否存在ASM进行分类。在血管内超声引导下的经皮冠状动脉介入治疗后，成功植入药物洗脱支架后ASM的总体患病率为每位患者14.4%，每处病变12.6%。与无ASM的病变相比，有ASM的病变支架内管腔面积更大、支架面积更大、支架内血管面积更大。与无ASM的病变相比，有ASM的病变观察到更大的平均斑块面积以及更衰减的斑块。与无ASM的病变相比，有ASM的病变近端和远端参考管腔面积更大，远端参考钙化更多，但近端没有。在2年随访中，有ASM的患者与无ASM的患者在心脏死亡、心肌梗死、早期、晚期或极晚期支架血栓形成或临床驱动的靶病变血运重建发生率方面无显著差异。此外，即使强行纳入多变量模型，ASM也不是2年主要不良心脏事件或靶病变血运重建的独立预测因素。
在接受血管内超声引导下药物洗脱支架植入治疗的患者中，ASM与包括但不限于支架血栓形成在内的长期随访期间的不良临床事件无关。
