Abstract 12014: Differences in Neointimal Coverage Among Bare-Metal Stent and 3 Types of Second-Generation Drug-Eluting Stents at 9 Months After Implantation Using Optical Coherence Tomography in Patients With ST-Segment Elevation Myocardial Infarction
Background: Percutaneous coronary intervention with drug-eluting stents for patients with ST-segment elevation myocardial infarction (STEMI) reduces target lesion revascularization, but drug-eluting stents have an increased risk of very late stent thrombosis. Endothelial coverage of stents is a key factor in stent thrombosis. This study examined neointimal coverage of bare-metal stent (BMS), and 3 types of second-generation drug-eluting stents [zotarolimus-eluting stent (E-ZES), everolimus-eluting stent (EES) and biolimus-eluting stent (BES)] in STEMI patients using optical coherence tomography (OCT).
Methods: Eighty-eight STEMI patients underwent follow-up coronary angiography and OCT at 9 months after stent implantation (BMS, n=22; E-ZES, n=21; EES, n=22; BES, n=23). Using OCT, we measured thickness inside every strut and area between struts and vessel wall, and evaluated neointimal coverage and malapposition of stents. The relationship of strut condition to remodeling index before percutaneous coronary intervention by intravascular ultrasound was also examined.
Results: As shown in the table 1, restenosis rate, neointimal coverage thickness and area rate were significantly lower with EES and BES than with BMS and E-ZES, while the malapposed rate was significantly higher in EES and BES. Uncovered struts were most frequently observed in EES. In addition, evagination/strut rate was highest in BES among the various stents, showing a significant correlation with positive remodeling by intravascular ultrasound (r=0.42, p=0.047).
Conclusions: Differences in neointimal coverage as assessed by OCT in BMS, E-ZES, EES and BES were found after 9-month implantation in STEMI patients. This might cause differences in the development of stent thrombosis. Furthermore, E-ZES might have potential to lead to early discontinuation of dual antiplatelet therapy among these second-generation drug-eluting stents.
- © 2013 by American Heart Association, Inc.