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Role of residual acute stent malapposition in percutaneous coronary interventions
Author(s) -
Romagnoli Enrico,
Gatto Laura,
La Manna Alessio,
Burzotta Francesco,
Taglieri Nevio,
Saia Francesco,
Amico Francesco,
Marco Valeria,
Ramazzotti Vito,
Di Giorgio Alessandro,
Di Vito Luca,
Boi Alberto,
Contarini Marco,
Castriota Fausto,
Mintz Gary S.,
Prati Francesco
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26974
Subject(s) - medicine , mace , cardiology , percutaneous coronary intervention , acute coronary syndrome , stent , context (archaeology) , myocardial infarction , paleontology , biology
Objectives Assess clinical consequences of acute stent malapposition (ASM) in the context of the multicenter Centro per la Lotta Contro l'Infarto‐Optimization of Percutaneous Coronary Intervention (CLI‐OPCI) registry. Background ASM as important determinant of stent thrombosis (ST) risk remains controversial. Methods From 2009 to 2013, we retrospectively analyzed postprocedural optical coherence tomography (OCT) findings in 864 patients undergoing percutaneous coronary intervention, assessing prevalence and magnitude of ASM and exploring correlation with outcome, especially ST. Results Postprocedural OCT revealed a variable grade of ASM in 72.3% of stents without correlation between maximal strut‐vessel distance and longitudinal extension ( R = 0.164, P < 0.01). At a median follow up of 302 (IQ 127–567) days, ASM did not affect risk of following major cardiac adverse events (MACE); residual ASM was comparable in terms of thickness (median [quartiles] 0.21[IQ 0.1–0.4] vs. 0.20[IQ 0.0–0.3], P = 0.397) and length (2.0[IQ 0.5–4.1] vs. 2.2[IQ 0.0–5.2], P = 0.640) in patients with versus without MACE. The predictive accuracy for outcome was low (C‐statistic 0.52, CI 95% 0.47–0.58, P = 0.394) as well for target lesion revascularization (HR 0.80, CI 95% 0.5–1.4) and ST (HR 0.71, CI 95% 0.3–1.5). Likewise, timing to MACE was not influenced by presence of such an ASM with similar rate of acute‐subacute (HR 1.09, CI 95% 0.6–1.9), late (HR 0.91, CI 95% 0.5–1.8), and very late (HR 1.23, CI 95% 0.5–2.9) events. Conclusions Limited ASM was a common finding after stent implantation, but was not associated to increased risk of stent failure or ST during mid‐term follow‐up. © 2017 Wiley Periodicals, Inc.