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Limits: Publication Date from 2003/10/01 to
2005/02/01

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1:
Circulation. 2004 Feb 24;109(7):881-6. Epub 2004 Feb 16.

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Incidence, mechanism,
predictors, and long-term prognosis of late stent malapposition after
bare-metal stent implantation.

Hong MK, Mintz GS,
Lee CW, Kim YH, Lee SW, Song JM, Han KH, Kang DH, Song JK, Kim JJ, Park
SW, Park SJ.

Department of Medicine, University of Ulsan
College of Medicine, Cardiac Center, Asan Medical Center, Seoul,
Korea.

BACKGROUND: Predictors and long-term prognosis of late
stent malapposition (LSM) after bare-metal stent (BMS) implantation are
unknown. METHODS AND RESULTS: We evaluated the incidence, mechanisms,
predictors, and long-term prognosis of LSM after BMS implantation in 881
patients (992 native lesions) in whom intravascular ultrasound was
performed at index and 6-month follow-up. LSM was defined as a
separation of stent struts from the intimal surface of the arterial wall
that was not presented at stent implantation. LSM occurred in 54
patients with 54 lesions (5.4% overall); the incidence was 10.3% (9 of
87) after directional coronary atherectomy (DCA) before stenting and
11.5% (11 of 96) after primary stenting in acute myocardial infarction
(P=0.031 and P=0.007, respectively, versus elective stenting with
conventional balloon pre-dilation, 4.3% [30 of 692]). There was an
increase of external elastic membrane area (18.9+/-3.9 to 24.5+/-5.1
mm2, P<0.001) that was greater than the increase in plaque area
(9.6+/-3.0 to 11.4+/-2.9 mm2, P<0.001). Independent predictors of LSM
were primary stenting in acute myocardial infarction (P=0.023, OR=2.55,
95% CI=1.14 to 5.69) and DCA before stenting (P=0.025, OR=3.02, 95%
CI=1.15 to 7.96). There were no significant differences in major adverse
cardiac events between LSM and non-LSM groups during mean 3-year
follow-up (1.9% versus 1.8%, respectively, P=NS). CONCLUSIONS: LSM
occurs in approximately 5% after BMS implantation. The predictors of LSM
are primary stenting in acute myocardial infarction and DCA before
stenting. Compared with complete stent apposition at follow-up, LSM
after BMS implantation is not associated with any major adverse cardiac
events during a mean 3-year follow-up after detection of
LSM.

PMID: 14967732 [PubMed - indexed for MEDLINE]

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