Abstract
BackgroundStent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation.MethodsThis study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR).ResultsOf 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED.ConclusionsSED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.
Highlights
Stent implantation can result in vessel wall injury between the edge of a stent and the adjacent vessel wall [1, 2]
The stent edge dissection (SED) group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR)
After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of major adverse cardiac events (MACE) compared with the non-SED group
Summary
Stent implantation can result in vessel wall injury between the edge of a stent and the adjacent vessel wall [1, 2]. It has been previously reported that residual stent edge dissection (SED) has been associated with a high rate of stent thrombosis and major adverse cardiac events (MACE) [3,4,5]. Previous data showing a relationship between SED and worse clinical outcomes has been demonstrated mainly by angiography or IVUS [3,4,5]. Several studies showed that SED detected by OCT was associated with worse clinical outcomes, there is still a controversy as to whether SED detected by OCT affects clinical outcomes [9,10,11,12,13,14]. Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation
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