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

Räber, Lorenz; Zanchin, Thomas; Baumgartner, Sandro; Taniwaki, Masanori; Moschovitis, Aris; Kalesan, Bindu; Garcia Garcia, Hector Manuel; Justiz, Jörn; Pilgrim, Thomas; Wenaweser, Peter Martin; Meier, Bernhard; Jüni, Peter; Windecker, Stephan (2014). 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. International journal of cardiology, 173(2), pp. 259-267. Elsevier 10.1016/j.ijcard.2014.02.036

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BACKGROUND 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Räber, Lorenz; Taniwaki, Masanori; Moschovitis, Aris; Kalesan, Bindu; Garcia Garcia, Hector Manuel; Pilgrim, Thomas; Wenaweser, Peter Martin; Meier, Bernhard; Jüni, Peter and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0167-5273

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

06 Oct 2014 15:11

Last Modified:

18 Dec 2014 16:01

Publisher DOI:

10.1016/j.ijcard.2014.02.036

PubMed ID:

24631113

Additional Information:

Räber and Zanchin contributed equally to this work.

Uncontrolled Keywords:

Acute coronary syndrome Arterial healing Drug-eluting stent Optical coherence tomography

BORIS DOI:

10.7892/boris.48170

URI:

https://boris.unibe.ch/id/eprint/48170

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