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Malapposed, protruding struts in DES more likely in ACS over long term
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Uncovered, malapposed and protruding struts all occurred more frequently in patients with ACS than in those with stable CAD 5 years after DES implantation, concluded a recent study that utilized optical coherence tomography.
According to the researchers, DES has been associated with delayed arterial healing in culprit lesions in patients with ACS compared with those with stable CAD. However, whether this persists through long-term follow-up is unknown. The current study was a comparison of the differences in arterial healing between these two populations as measured by OCT 5 years after DES implantation.
The analysis included 88 patients. There were 53 ACS lesions with 7,864 struts and 35 stable lesions with 5,298 struts.
Strut coverage, malapposition, protrusion, evaginations and cluster formation served as the OCT endpoints.
Uncovered struts occurred more frequently in the ACS group compared with the CAD group (1.7% vs. 0.7%; adjusted P=.041). Similarly, protruding struts occurred in 0.5% of the ACS group and 0.13% of the CAD group (P=.038).
Malapposed struts occurred in 1.33% of the ACS group and 0.45% of the CAD group (P=.072).
Thirty-four percent of patients with ACS demonstrated uncovered or malapposed/protruding struts compared with 14.1% of stable patients (P=.041).
Patients with STEMI were more likely to experience coronary evaginations than those with stable CAD (0.16 vs. 0.13 per cross section; P=.027).
“Uncovered, malapposed and protruding stent struts, as well as clusters of delayed healing, may be more frequent in culprit lesions of ACS compared with stable CAD patients late after DES implantation,” the researchers concluded. “Our observational findings suggest a differential healing response attributable to lesion characteristics of patients with ACS compared with stable CAD in-vivo.”
Disclosure: The researchers report financial disclosures with Abbott, Biotronik, Biosensors, Boston Scientific, Cordis, Johnson & Johnson and Medtronic.
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