Impact of Positive Peri-Stent Vascular Remodeling After Sirolimus-Eluting and Paclitaxel-Eluting Stent Implantation on 5-Year Clinical Outcomes – Intravascular Ultrasound Analysis From the Poststent Optimal Stent Expansion Trial Multicenter Randomized Trial –

Ki-Woon Kang; Young-Guk Ko; Dong-Ho Shin; Jung-Sun Kim; Byeong-Keuk Kim; Donghoon Choi; Myeong-Ki Hong; Woong Chol Kang; Taehoon Ahn; Dong Woon Jeon; Joo-Young Yang; Yangsoo Jang

doi:10.1253/circj.CJ-11-1313

Cardiovascular Intervention

Impact of Positive Peri-Stent Vascular Remodeling After Sirolimus-Eluting and Paclitaxel-Eluting Stent Implantation on 5-Year Clinical Outcomes

– Intravascular Ultrasound Analysis From the Poststent Optimal Stent Expansion Trial Multicenter Randomized Trial –

Ki-Woon Kang, Young-Guk Ko, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Donghoon Choi, Myeong-Ki Hong, Woong Chol Kang, Taehoon Ahn, Dong Woon Jeon, Joo-Young Yang, Yangsoo Jang

Author information

Ki-Woon Kang
Division of Cardiology, Eulji University Hospital
Young-Guk Ko
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
Dong-Ho Shin
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
Jung-Sun Kim
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
Byeong-Keuk Kim
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
Donghoon Choi
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
Myeong-Ki Hong
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
Woong Chol Kang
Division of Cardiology, Gil Heart Center, Gachon Medical School
Taehoon Ahn
Division of Cardiology, Gil Heart Center, Gachon Medical School
Dong Woon Jeon
Division of Cardiology, NHIC Ilsan Hospital
Joo-Young Yang
Division of Cardiology, NHIC Ilsan Hospital
Yangsoo Jang
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine

Keywords: Coronary artery disease, Drug-eluting stent, Late and very late stent thrombosis, Vascular remodeling

JOURNAL FREE ACCESS

2012 Volume 76 Issue 5 Pages 1102-1108

DOI https://doi.org/10.1253/circj.CJ-11-1313

View "Advance Publication" version (March 1, 2012).

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Abstract

Background: Positive peri-stent vascular remodeling (PPVR) after drug-eluting stent (DES) implantation is an important mechanism of late-acquired stent malapposition (LASM). Methods and Results: A total of 226 patients (sirolimus-eluting stent [SES], n=105; paclitaxel-eluting stent [PES], n=121) from the Poststent Optimal Stent Expansion Trial who underwent a post-intervention and 9-month follow-up intravascular ultrasound were followed clinically for 5 years. PPVR was arbitrarily defined as a >10% increase in the external elastic membrane volume index at follow-up. PPVR and LASM occurred more frequently with SESs than with PESs. The 5-year rate of major adverse cardiac events was lower with SES than with PES (10.7% vs. 23.2%, P=0.002). The late and very late stent thrombosis (ST) rate was similar between the 2 DES types, but it was higher in patients with PPVR than in those without PPVR (8.8% vs. 1.3%, P=0.009) regardless of the DES type. Early discontinuation (<1 year) of dual antiplatelet therapy (DAPT; hazard ratio [HR], 24.14; 95% confidence interval [CI]: 4.90-118.87; P<0.001), PPVR (HR, 14.94; 95%CI: 1.85-120.46; P=0.011), LASM (HR, 8.01; 95%CI: 1.93-33.16; P=0.004), and stent length (HR, 1.14; 95%CI: 0.98-1.32 per mm; P=0.078) were associated with increased risk of late and very late ST. Conclusions: PPVR and LASM development after DES implantation, along with early discontinuation of DAPT and longer stent length, are important risk factors of late and very late ST. (Circ J 2012; 76: 1102-1108)

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