Long-Term Vascular Healing in Response to Sirolimus- and Paclitaxel-Eluting Stents

Abstract

Early-generation drug-eluting stents show a similar degree of strut coverage and malapposition at 5 years of follow-up. Despite an overall low degree of uncovered and malapposed struts in event-free patients, some lesions show a clustering of these characteristics, indicating a heterogeneous healing response, which may be the source for very late adverse events.

Five-Year Optical Coherence Tomography in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Bare-Metal Versus Everolimus-Eluting Stents

“…6,14 OCT studies have observed >5% of uncovered struts in >65% of patients with drug-eluting very-late ST. 6,16 Fiveyear OCT imaging of event-free patients treated with sirolimus-or paclitaxel-eluting stents showed that the percentage of patients with uncovered struts >5% was 10.7% with sirolimusand 7.2% with paclitaxel-eluting stents. 17 In the present study, including only STEMI patients, 32.3% and 6.5% of patients treated with EES and BMS had >5% of uncovered struts.…”

Intricacies in the analysis and interpretation of optical coherence tomography findings

“…The multilevel logistic regression model as described above is estimated with a Bayesian approach based on uninformative priors 3,9 . The results obtained by the individual methods are presented in Table 1 and Figure 1.…”

“…The conclusion of the multilevel models is correct but only as a statement regarding the majority of lesions; however, it does not capture the response of a few lesions with the highest level of malapposition. These lesions must be handled separately as done for example in Räber et al 9 . The GEE results are mainly driven by a few lesions.…”

“…A graphical representation where the clinically relevant units (here: lesions) are plotted 9,18 should ideally be reported to allow a fully informed comparison of the groups. The multilevel and aggregated analysis methods are both correct if the percentage estimators are to be interpreted at lesion level.…”

Drug-Eluting Coronary-Artery Stents

“…2). 20 Early-generation sirolimus-and paclitaxeleluting stents were associated with delayed arterial healing -manifested as incomplete endothelialization of stent struts, vessel remodeling, and persistent fibrin and platelet deposition 20,21 -and with premature neoatherosclerosis. 22 Improved endothelial coverage has been reported after implantation of everolimus-and zotarolimus-eluting stents in studies in animals 23 and in clinical studies with intracoronary imaging.…”