Impact of late stent malapposition after drug-eluting stent implantation on long-term clinical outcomes.

Abstract

BACKGROUND AND AIMS\nThe impact of late drug-eluting stent (DES) malapposition detected by optical coherence tomography (OCT) on long-term clinical outcomes has not been clearly established. We evaluated long-term clinical outcomes of late stent malapposition (LSM) detected by OCT in a qualified study population.\n\n\nMETHODS\nA total of 428 patients were selected from previous randomized OCT studies that evaluated the degree of strut coverage of different DESs at a 3-12-month follow-up OCT examination. These patients were assigned to one of two groups based on the presence (n\u202f=\u202f136) or absence (n\u202f=\u202f292) of LSM on follow-up OCT images (performed at 7.0\u202f±\u202f3.4 months after DES implantation). The cumulative rates of composite events (cardiac death, target-vessel-related myocardial infarction, target-vessel revascularization, and stent thrombosis) were compared between the two groups.\n\n\nRESULTS\nDuring 73.7\u202f±\u202f18.3 months of follow-up, cardiac death or (very) late stent thrombosis did not occur in either group. The cumulative rate of composite events was similar among the patients in each group (6.2% in patients with LSM vs. 11.7% in those without LSM) [hazard ratio (HR)\u202f=\u202f0.569, 95% confidence interval (CI)\u202f=\u202f0.257-1.257, p\u202f=\u202f0.163]. Target vessel-related myocardial infarction occurred in 0.7% of patients with LSM vs. 1.5% of those without LSM (HR\u202f=\u202f0.521, 95% CI\u202f=\u202f0.058-4.670, p\u202f=\u202f0.560). Target-vessel revascularization was performed in 5.4% of patients with LSM vs. 10.2% of those without LSM (HR\u202f=\u202f0.574, 95% CI\u202f=\u202f0.246-1.343, p\u202f=\u202f0.201).\n\n\nCONCLUSIONS\nCardiac death or (very) late stent thrombosis did not occur in patients with OCT-detected LSM during long-term follow-up. The presence of OCT-detected LSM was not associated with adverse clinical events.