Abstract 4728: Higher Maximal Stent Inflation Pressure During Drug Eluting Stent Implantation is Protective Against MACE and Stent Thrombosis: Three Year Data From the Montreal Heart Institute DES Registry
Background: Although stent malapposition has been known to play an important part in determining adverse outcome post DES, the specific impact of maximal inflation pressure on MACE has not been evaluated.
Methods and results: Data were studied in a single center DES database with available online QCA data for patients receiving a single stent. A total of 362 consecutive patients were studied; 92.7% had follow-up at 3 years. Clopidogrel duration was for 1 year. Mean age was 61.7±11.1y, 32.3% were diabetic, 74.5% were ACC/AHA group B2/C lesions and 27.9% were treated for acute myocardial infarction. 64.9% received a Taxus stent and the remainder Cypher. Of 348 with complete follow up, 74 had a maximal inflation pressure <12 atm and 274 ≥12 atm. Stent:artery ratio was 1:1 in 99.5%. Postdilatation was performed in 43.2% and this was unrelated to MACE. Of clinical and angiographic factors, age (p=0.016), hypertension (p=0.038), diabetes (p=0.003), prior CABG (p=0.001) were positively related to MACE by univariate analysis in a Cox regression model. Higher maximal inflation pressure (p±0.023) and inflation pressure≥12 atm (p=0.041) were inversely related to MACE. Only diabetes (p=0.013, adjusted OR 1.98, 95% CI 1.15–3.39), multivessel disease (p=0.041, adjusted OR 1.85, 95% CI 1.02–3.34) and maximal stent inflation pressure and inflation pressure≥12 atm (p=0.013; adjusted OR 0.48, 95% CI 0.27–0.86) were significant independent predictors of MACE in the multivariate Cox Regression model.
Conclusion: Higher maximal pressure of inflation during DES implantation is associated with significantly reduced MACE and stent thrombosis and trends towards reduced TVR and death/MI (see figure⇓).