Abstract 4552: Does ‘Late Catch-Up’ Exist in Drug Eluting Stents? Insights From a Serial Quantitative Coronary Angiography Analysis
Background: Recent studies have suggested the possibility of delayed occurrence of late loss, so called the ‘late catch up phenomenon’ after drug eluting stent (DES) implantation especially in ’limus’ drug eluting stents. There is limited data on whether latch catch up exists in drug eluting stents such as sirolimus-(SES) and paclitaxel-eluitng stents (PES).
Methods: To address this issue, we performed a serial quantitative coronary angiographic (QCA) analysis of lesions for which there were two or more angiographic follow-ups available at least one year apart from each other after implantation of DES. The first (early) angiographic follow-up (FU) was routinely recommended at 6 to 9 months post-PCI and the second (late) angiographic follow-up was performed at 18 –24 months post-PCI. We excluded all lesions that that received target lesion revascularization (TLR) at first FU. Early luminal loss (LL) was defined as the difference in minimal luminal diameter (MLD) between the 1st angiographic FU and immediate post-PCI, while delayed LL was defined as difference in MLD between the 2nd and 1st angiographic FU.
Results: We identified 412 lesions in 307 patients, 128 lesions in the Taxus group and 284 lesions in the Cypher group, whose index PCI was performed from January 2004 to December 2006. As expected, the early LL in-stent was significantly higher in the Taxus group compared with the Cypher group (0.56 vs. 0.20mm, p<0.01). However the delayed LL that occurred after the 1st angiographic FU was significantly higher in the Cypher group (0.10 vs. 0.28mm, p<0.01), suggesting that occurrence of delayed late loss was more prominent in Cypher stents. On correlation analysis, in contrast to Taxus stents where early LL showed the best correlation with total LL (correlation coefficient 0.81 vs. 0.30 for early vs. late LL), delayed LL showed the best correlation with total LL in Cypher stents (correlation coefficient 0.42 vs. 0.91 for early vs. delayed LL), suggesting that the LL that occurs after 1st angiographic FU better explains the total LL in Cypher stents.
Conclusion: There is added accumulation of neointima, so-called ‘late catch-up’ after 6 –9 months in patients receiving DES. The occurrence of delayed late loss seems to be more prominent in Cypher compared with Taxus stents.