Stent malapposition after sirolimus-eluting and bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: acute and 9-month intravascular ultrasound results of the MISSION! intervention study.

OBJECTIVES Acute and late stent malapposition (SM) after bare-metal stents (BMS) and sirolimus-eluting stents (SES) in ST-segment elevation myocardial infarction patients were studied. BACKGROUND Stent thrombosis may be caused by SM after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients. METHODS Post-procedure and follow-up intravascular ultrasound data were available in 184 out of 310 patients (60%; 104 SES, 80 BMS) included in the MISSION! Intervention Study. To determine the contribution of remodeling and changes in plaque burden to the change in lumen cross-sectional area (CSA) at SM sites, the change in lumen CSA (follow-up minus post-lumen CSA) was related to the change in external elastic membrane CSA (remodeling) and change in plaque and media CSA (plaque burden). RESULTS Acute SM was found in 38.5% SES patients and 33.8% BMS patients (p = 0.51), late SM in 37.5% SES patients and 12.5% BMS patients (p < 0.001). Acquired SM was found in 25.0% SES patients and 5.0% BMS patients (p < 0.001). Predictors of acute SM were reference diameter (SES: odds ratio [OR] 3.49, 95% confidence interval [CI] 1.29 to 9.43; BMS: OR 28.8, 95% CI 4.25 to 94.5) and balloon pressure (BMS: OR 0.74, 95% CI 0.58 to 0.94). Predictors of late SM were diabetes mellitus (SES: OR 0.16, 95% CI 0.02 to 1.35), reference diameter (BMS: OR 19.2, 95% CI 2.64 to 139.7), and maximum balloon pressure (BMS: OR 0.74, 95% CI 0.55 to 1.00). Change in lumen CSA was related to change in external elastic membrane CSA (R = 0.73, 95% CI 0.62 to 0.84) after SES implantation and to change in plaque and media CSA (R = -0.62, 95% CI -0.77 to -0.46) after BMS implantation. After SES implantation, acquired SM was caused by positive remodeling in 84% and plaque reduction in 16% of patients. CONCLUSIONS Acute SM was common after SES and BMS stent implantation in ST-segment elevation myocardial infarction patients. After SES implantation, late acquired SM is common and generally caused by positive remodeling.

[1]  Patrick Hunziker,et al.  Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. , 2006, Journal of the American College of Cardiology.

[2]  S. Romano,et al.  Rapamycin antagonizes NF-kappaB nuclear translocation activated by TNF-alpha in primary vascular smooth muscle cells and enhances apoptosis. , 2006, American journal of physiology. Heart and circulatory physiology.

[3]  Michael Joner,et al.  Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. , 2006, Journal of the American College of Cardiology.

[4]  C. Macaya,et al.  Findings of intravascular ultrasound during acute stent thrombosis , 2004, Heart.

[5]  Jeroen J. Bax,et al.  MISSION!: optimization of acute and chronic care for patients with acute myocardial infarction. , 2007, American heart journal.

[6]  N. Weissman,et al.  Underexpansion of sirolimus‐eluting stents: Incidence and relationship to delivery pressure , 2005, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[7]  P. Teirstein,et al.  Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study. , 2000, Circulation.

[8]  M. Leon,et al.  Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study. , 1996, Circulation.

[9]  Stéphane G Carlier,et al.  Clinical researchInterventional cardiologyStent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: An intravascular ultrasound study , 2005 .

[10]  P. Fitzgerald,et al.  Comparison of zotarolimus-eluting and sirolimus-eluting stents in patients with native coronary artery disease: a randomized controlled trial. , 2006, Journal of the American College of Cardiology.

[11]  J. Reiber,et al.  Advanced contour detection for three-dimensional intracoronary ultrasound: a validation – in vitro and in vivo , 2002, The International Journal of Cardiovascular Imaging.

[12]  B. Gersh.  Incidence, Predictors, and Outcome of Thrombosis After Successful Implantation of Drug-Eluting Stents , 2006 .

[13]  Gary S. Mintz,et al.  Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses: Final Results of a Randomized Comparison With Angiographic Guidance (TULIP Study) , 2003, Circulation.

[14]  StéphaneCook,et al.  Incomplete Stent Apposition and Very Late Stent Thrombosis After Drug-Eluting Stent Implantation , 2007 .

[15]  David J Cohen,et al.  Stent Thrombosis After Successful Sirolimus-Eluting Stent Implantation , 2004, Circulation.

[16]  Seung‐Jung Park,et al.  Late Stent Malapposition After Drug-Eluting Stent Implantation: An Intravascular Ultrasound Analysis With Long-Term Follow-Up , 2006, Circulation.

[17]  Patrick W Serruys,et al.  Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy , 2004, The Lancet.

[18]  S. Romano,et al.  Rapamycin antagonizes NF-κB nuclear translocation activated by TNF-α in primary vascular smooth muscle cells and enhances apoptosis , 2006 .

[19]  P. Serruys,et al.  A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. , 2002, The New England journal of medicine.

[20]  C. Tracy,et al.  American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. , 2001, Journal of the American College of Cardiology.

[21]  Gd Rotterdam.  Incomplete stent apposition after implantation of paclitaxel- eluting stents or bare metal stents: Insights from the randomized TAXUS II trial , 2005 .

[22]  S Doucet,et al.  Stent Placement to Prevent Restenosis After Angioplasty in Small Coronary Arteries , 2001, Circulation.

[23]  Seung‐Jung Park,et al.  Incidence, Mechanism, Predictors, and Long-Term Prognosis of Late Stent Malapposition After Bare-Metal Stent Implantation , 2004, Circulation.

[24]  H. Putter,et al.  Sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: 9-month angiographic and intravascular ultrasound results and 12-month clinical outcome results from the MISSION! Intervention Study. , 2008, Journal of the American College of Cardiology.

[25]  R. Herrmann,et al.  Comparative Effects of Paclitaxel and Rapamycin on Smooth Muscle Migration and Survival: Role of Akt-Dependent Signaling , 2006, Arteriosclerosis, thrombosis, and vascular biology.

[26]  P. Fitzgerald,et al.  Vascular response to sirolimus‐eluting stents delivered with a nonaggressive implantation technique: Comparison of intravascular ultrasound results from the multicenter, randomized E‐SIRIUS, and SIRIUS trials , 2005, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[27]  K Walsh,et al.  Evidence for the rapid onset of apoptosis in medial smooth muscle cells after balloon injury. , 1997, Circulation.

[28]  Correlates and Long-Term Outcomes of Angiographically Proven Stent Thrombosis With Sirolimus- and Paclitaxel-Eluting Stents , 2006 .

[29]  Giuseppe Musumeci,et al.  Localized Hypersensitivity and Late Coronary Thrombosis Secondary to a Sirolimus-Eluting Stent: Should We Be Cautious? , 2004, Circulation.

[30]  A. Yeung,et al.  Predictors and outcomes of stent thrombosis: an intravascular ultrasound registry. , 2002, European heart journal.

[31]  Late incomplete stent apposition after sirolimus-eluting stent implantation: a serial intravascular ultrasound analysis. , 2005, Journal of the American College of Cardiology.

[32]  G. Stone,et al.  Outcome after acute incomplete sirolimus-eluting stent apposition as assessed by serial intravascular ultrasound. , 2006, The American journal of cardiology.