Late stent strut apposition and coverage after drug-eluting stent implantation by optical coherence tomography in patients with acute myocardial infarction.

BACKGROUND

Although drug-eluting stents (DES) are effective, stent thrombosis (ST) remains a major concern in patients with acute myocardial infarction (AMI) who undergo DES implantation. We aimed to evaluate the incidence of late stent malapposition (SM) and uncovered struts 12 months after implantation of a bioabsorbable polymer everolimus-eluting stent (BP-EES) or a durable polymer zotarolimus-eluting stent (DP-ZES) in patients with AMI using optical coherence tomography (OCT).

METHODS

Sixty-nine patients with AMI were randomly assigned 2:1 to the BP-EES (46 patients) or DP-ZES (23 patients) groups. The coprimary endpoints were the incidences of late SM and uncovered stent struts in OCT strut-level analysis at 12 months postimplantation.

RESULTS

The 51 patients who completed the 12-month follow-up OCT (BP-EES, 36 patients, 39 lesions; DP-ZES, 15 patients, 18 lesions) showed no intergroup differences in the incidence of acute SM (BP-EES vs. DP-ZES; 12.25 ± 14.27% vs. 12.35 ± 10.55%, P = 0.981) at the index procedure. The incidence of late SM (0.12 ± 0.42% vs. 0.14 ± 0.25%, P = 0.873) and uncovered struts (1.69 ± 3.44% vs. 2.45 ± 3.23%, P = 0.532) also did not differ between the two DES groups at 12-month postimplantation.

CONCLUSION

Twelve-month OCT measurements showed no significant differences in late SM and uncovered struts between the BP-EES and DP-ZES stents. Thus, contemporary second-generation DES show a very low rate of late SM and uncovered struts after 12 months in AMI, regardless of stent polymer type.

TRIAL REGISTRATION

Late stent strut apposition and coverage after drug-eluting stent implantation by OCT in patients with AMI (APPOSITION AMI-II) (NCT02770651).