Abstract 16295: Smaller Stent Area and Eccentric Expansion are Associated With Increased Adverse Events After Drug-eluting Stent Implantation in Hemodialysis Patients

Abstract

Introduction: Factors for adverse cardiac events after drug-eluting stent (DES) implantation among patients with hemodialysis (HD) remain to be elucidated. Hypothesis: Suboptimal DES implantation is associated with the increased incidence of adverse events in patients with HD. Methods: A total of 109 consecutive patients with HD who underwent optical coherence tomography (OCT)-guided DES implantation were included. The impact of post-stent OCT findings on the incidence of device-oriented clinical endpoints (DoCE) at 1 year was investigated. DoCE included cardiac death, target vessel-related myocardial infarction, target lesion revascularization, and stent thrombosis. Results: There was no significant difference in baseline clinical characteristics and pre-stent lesion characteristics between patients with DoCE (n=15) and those without DoCE (n=94). Significant hazard ratio (HR) for the incidence of DoCE was not observed in the presence of edge dissection, irregular protrusion, or incomplete stent apposition (Panel A). In receiver operating characteristic curve analyses, the best cutoff of minimum stent cross-sectional area (MSA), %stent expansion [MSA / mean reference lumen cross-sectional area х 100], and eccentricity index (minimum stent diameter / maximum stent diameter) at MSA site for detecting DoCE was 3.4 (mm 2 ), 72.0 (%), and 0.71, respectively. Significant HR for the incidence of DoCE was observed in the presence of MSA< 3.4 (HR 3.58, 95% confidence interval [CI] 1.04 - 12.4, p=0.035) and eccentricity index< 0.71 (HR 6.68, 95% CI 1.94 - 23.0, p=0.001) (Panel B). Conclusions: Smaller stent area and eccentric expansion were associated with increased incidence of DoCE after DES implantation in patient with HD, although the presence of other post-stent suboptimal findings were not associated with the incidence of DoCE. The present results suggest the importance of larger stent area and concentric stent expansion in patients with HD.