Abstract 2642: Impact of Late Incomplete Stent Apposition After Sirolimus-Eluting Stent Implantation on 3-Year Clinical Events. Intravascular Ultrasound Analysis from the Multicenter, Randomized, RAVEL, E-SIRIUS and SIRIUS Trials
Incomplete stent apposition (ISA) has been reported to be more frequent after drug-eluting stents than after bare-metal stents (BMS). Its impact on late clinical events after cessation of dual antiplatelet therapy has remained unclear. We sought to evaluate the clinical impact of ISA during a follow-up period of several years.
Methods. From the RAVEL, the SIRIUS and E-SIRIUS trials, three randomized, multicenter studies comparing sirolimus-eluting stents (SES) and BMS, intravascular ultrasound (IVUS; at stent implantation and/or eight-months follow-up) was available in 407 patients (BMS: n=191, SES: n=216). The IVUS images were reviewed for the presence of ISA. Clinical follow-up (MACE, stent thrombosis) was available for a 4 year period in RAVEL patients and a 3 year period in SIRIUS and E-SIRIUS patients.
Results. 76 patients had incomplete stent apposition (BMS: n= 22 [12%], SES: n=54 [25%]). MACE rates were higher after BMS (29%) compared to after SES (12%; p<0.001). After BMS 0 pt (0%) and after SES 1 pt (0.5%) had late stent thrombosis (p=0.951). Considering only the SES patients ISA had no negative impact on clinical events rates during 3 or 4 year follow-up, respectivly (see Table⇓). ISA was not identified as factor with negative impact on the occurrence of late stent thrombosis.
Conclusions. ISA rates were unexpectedly high both with BMS and SES. However, it appears to be an IVUS finding without any clinical sequal even during long-term follow-up after discontinuation of dual anti-platelet therapy.