Abstract
Background and ObjectivesSecond‐generation drug‐eluting stents (G2‐DES) are associated with a lower rate of acute and subacute stent thrombosis compared with bare‐metal stent (BMS) in the setting of ST‐segment elevation myocardial infarction (STEMI). In this study, our aim was to compare the vascular response and thrombus burden between G2‐DES and BMS in early‐phase STEMI.MethodsBetween May 2010 and August 2014, a total of 41 STEMI patients treated by either G2‐DES (n = 26; everolimus‐eluting stent [EES]: n = 15, zotarolimus‐eluting stent [ZES]: n = 11) or BMS (n = 15) and, with multivessel disease requiring additional percutaneous coronary intervention (PCI), were prospectively enrolled. Optical coherence tomography (OCT) imaging was performed at 1 month after stent implantation.ResultsBaseline clinical characteristics, except for age (61.5 ± 9.3 vs 69.3 ± 9.8, P = 0.01, t test), were comparable between patients with drug‐eluting stent (DES) and BMS. The incidence of residual thrombus after the stent implantation for STEMI was comparable between DES and BMS (7.7% vs 6.7%, P = 0.88, χ 2 test). At 1 month, thrombus burden, defined as the mean thrombus area divided by the mean lumen area, was significantly smaller with DES than with BMS (median interquartile range (IQR), 1.2 (0.0, 1.0) vs 1.2 (0.0, 2.2), P = 0.04, Mann‐Whitney U test), despite a similar percentage of malapposed (median (IQR), 6.2 (2.4, 9.0) vs 2.6 (0.0, 5.8)%, P = 0.07, Mann‐Whitney U test) or uncovered struts (median (IQR), 6.8 (1.8, 13.1) vs 6.14 (2.8, 18.5)%, P = 0.45, Mann‐Whitney U test). No significant difference in thrombus burden was observed between EES and ZES.ConclusionsThrombus burden was significantly smaller with DES than with BMS at 1‐month follow‐up in STEMI cases, although the percentage of malapposed or uncovered struts was similar between the groups. This may partly explain the lower rate of acute and subacute stent thrombosis in G2‐DES that has previously been reported in the literature.
Highlights
‐called second‐generation drug‐eluting stents (G2‐DES) have been developed to overcome residual safety concerns from first‐ generation drug‐eluting stent (DES),[1,2,3,4] delayed reendothelialization is still considered to be an inevitable safety matter in any type of DES.[510]
The incidence of residual thrombus after the stent implantation for segment elevation myocardial infarction (STEMI) was comparable between DES and bare‐metal stent (BMS) (7.7% vs 6.7%, P = 0.88, χ2 test)
Thrombus burden was significantly smaller with DES than with BMS at 1‐month follow‐up in STEMI cases, the percentage of malapposed or uncovered struts was similar between the groups
Summary
‐called second‐generation drug‐eluting stents (G2‐DES) have been developed to overcome residual safety concerns from first‐ generation drug‐eluting stent (DES),[1,2,3,4] delayed reendothelialization is still considered to be an inevitable safety matter in any type of DES.[510]. The safety of DES in acute and subacute phases in cases of ST‐segment elevation myocardial infarction (STEMI) was debated as a result of the activated thrombogenicity,[11,12] instability of residual plaque,[13] and higher frequency of suboptimal results in the procedure.[14,15] contrary to expectations, a lower rate of definite stent thrombosis with an everolimus‐eluting stent (EES) compared with the bare‐metal stent (BMS) was demonstrated in the EXAMINATION (clinical Evaluation of the Xience‐V stent in Acute Myocardial INfArcTION) trial.[16] Surprisingly, the difference in the rate of thrombosis between the groups was most significant in acute and subacute phases. Optical coherence tomography (OCT) imaging was performed at 1 month after stent implantation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
