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Differential healing response attributed to culprit lesions of patients with acute coronary syndromes and stable coronary artery after implantation of drug-eluting stents: an optical coherence tomography study.

AbstractBACKGROUND:
Pathology studies have shown delayed arterial healing in culprit lesions of patients with acute coronary syndrome (ACS) compared with stable coronary artery disease (CAD) after placement of drug-eluting stents (DES). It is unknown whether similar differences exist in-vivo during long-term follow-up. Using optical coherence tomography (OCT), we assessed differences in arterial healing between patients with ACS and stable CAD five years after DES implantation.
METHODS AND RESULTS:
A total of 88 patients comprised of 53 ACS lesions with 7864 struts and 35 stable lesions with 5298 struts were suitable for final OCT analysis five years after DES implantation. The analytical approach was based on a hierarchical Bayesian random-effects model. OCT endpoints were strut coverage, malapposition, protrusion, evaginations and cluster formation. Uncovered (1.7% vs. 0.7%, adjusted p=0.041) or protruding struts (0.50% vs. 0.13%, adjusted p=0.038) were more frequent among ACS compared with stable CAD lesions. A similar trend was observed for malapposed struts (1.33% vs. 0.45%, adj. p=0.072). Clusters of uncovered or malapposed/protruding struts were present in 34.0% of ACS and 14.1% of stable patients (adj. p=0.041). Coronary evaginations were more frequent in patients with ST-elevation myocardial infarction compared with stable CAD patients (0.16 vs. 0.13 per cross section, p=0.027).
CONCLUSION:
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. Our observational findings suggest a differential healing response attributable to lesion characteristics of patients with ACS compared with stable CAD in-vivo.
AuthorsLorenz Räber, Thomas Zanchin, Sandro Baumgartner, Masanori Taniwaki, Bindu Kalesan, Aris Moschovitis, Hector M Garcia-Garcia, Jörn Justiz, Thomas Pilgrim, Peter Wenaweser, Bernhard Meier, Peter Jüni, Stephan Windecker
JournalInternational journal of cardiology (Int J Cardiol) Vol. 173 Issue 2 Pg. 259-67 (May 1 2014) ISSN: 1874-1754 [Electronic] Netherlands
PMID24631113 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Chemical References
  • Immunosuppressive Agents
  • Tubulin Modulators
  • Paclitaxel
  • Sirolimus
Topics
  • Acute Coronary Syndrome (pathology, therapy)
  • Aged
  • Angioplasty, Balloon, Coronary
  • Coronary Artery Disease (pathology, therapy)
  • Coronary Vessels (pathology)
  • Drug-Eluting Stents
  • Female
  • Humans
  • Immunosuppressive Agents (administration & dosage)
  • Male
  • Middle Aged
  • Paclitaxel (administration & dosage)
  • Sirolimus (administration & dosage)
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Tubulin Modulators (administration & dosage)
  • Wound Healing

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