Abstract 13671: Better Neointimal Formation of Paclitaxel Eluting Stent of the Patient With Multiple Risk Factor Compared With Sirolimus Eluting Stent -Optical Coherence Tomography Study-
Background: Late stent thrombosis (LST) relating to the inadequate neointimal coverage after drug-eluting stent (DES) implantation is a major clinical problem. Although diabetes mellitus is known to increase the risk of LST, the influence of diabetes on the neointimal coverage of DES has not fully clarified. In this study, we evaluated the relationship between diabetes and the characteristics of neointimal growth over the stent struts of sirolimus (SES) and paclitaxel-eluting stent (PES) by optical coherence tomography (OCT).
Methods: Sixty-four patients treated by DES (67.1±9.5 y/o, 27 patients with SES and 37 patients with PES) were enrolled, and 69 stented coronary segments were examined by OCT at routine follow-up angiography (7.8+/−1.3 month). Furthermore, PES was assessed as PES Express and new generation PES Liberte independently (29 PES Express, 12 PES Liberte). For the assessment of neointimal formation, cross-sectional OCT images were obtained at 1-mm intervals (every 15 frames) from distal to proximal edges of the stent. Neointima thickness (NIT), rate of uncovered stent strut, and rate of incomplete stent apposition (ISA) were measured.
Results: Compared to SES, NIT was significantly thicker, and uncovered rate was significantly lower in PES (53.2±26 vs. 164±122μm, p<0.001, 15.38 vs. 2.17%, p<0.001, respectively). ISA was more frequently observed in SES compared to PES (3.2 vs. 0.24%, p<0.001). In SES group, NIT was tended to be thinner and uncovered rate was significantly higher in diabetes than non-diabetes patients (NIT: 49±24 vs. 56±24μm, p=0.12, uncovered rate 19.4 vs 11.9%, p<0.0001). ISA was more frequently observed in SES with diabetes than without diabetes. Contrary to SES, both NIT and uncovered rate of PES were not influenced by the presence of diabetes (146±57 vs. 180±158μm, p=0.38, uncovered rate: 2.04 vs. 2.81% p=0.09). Furthermore, uncovered rate was significantly lower in PES Liberte compared to PES Express (0.98 vs. 2.5%, p=0.024) in diabetes patients.
Conclusions: In patients with diabetes, PES showed lower rate of uncovered stent strut compared to SES. New generation PES Liberte may be effective and safe in diabetes patients who underwent percutaneous coronary intervention.
- © 2010 by American Heart Association, Inc.