Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Abstract

BackgroundThe impact of acute stent malapposition (ASM) on long‐term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long‐term clinical outcomes of ASM.Methods and Results ADAPT‐DES (Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug‐eluting stents. In a prespecified intravascular ultrasound–guided substudy, 2072 patients with 2446 culprit lesions had post–percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound–guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug‐eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in‐stent lumen areas, larger stent areas, and larger in‐stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2‐year follow‐up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2‐year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model.ConclusionsIn patients treated with intravascular ultrasound–guided drug‐eluting stents implantation, ASM was not associated with adverse clinical events during long‐term follow‐up including, but not limited to, stent thrombosis.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.

Long-term Clinical Outcomes of Drug-Eluting Stent Malapposition

“…The IVUS study by Wang et al 6) included 2,072 patients with 2,446 lesions from ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study which was a prospective, multicenter registry designed to assess the relationship between platelet reactivity and other clinical and procedural variables vs subsequent stent thrombosis (ST) and adverse clinical events in patients successfully treated with drug-eluting stent (DES). At 2-year follow-up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late ST; or clinically driven target lesion revascularization in patients with ASM vs those without ASM.…”

Role of Lipid-Rich Plaques in Outcomes of Drug-Eluting Stent Implantation in Patients with Coronary Artery Disease

“…Клиническое значение малаппозиции недостаточно изучено. В нескольких исследованиях указано, что наличие малаппозиции после установки стентов с лекарственным покрытием не было ассоциировано с неблагоприятными событиями в длительном периоде наблюдения [16][17][18]. В то же время есть данные о связи неполной установки стента и тромбоза стента [7,19].…”

Second-Generation vs. First-Generation Drug-Eluting Stents in Patients With Calcified Coronary Lesions ― Pooled Analysis From the RESET and NEXT Trials ―

“…Also, optimal apposition often cannot be achieved in calcified lesions, which might lead to diminished tissue concentration of the antiproliferative drugs. [33][34][35] A current meta-analysis showed that the frequency of stent mal-apposition detected by optical coherence tomography may be lower in patients implanted with G2-DES 35 because these stents are thinner and more flexible than G1-DES. However, the magnitude of the effect of G2-DES relative to G1-DES for TLR and the secondary composite endpoints was not different between calcified and non-calcified lesions.…”

“…7,8 Also, the extent of mal-apposition may not be related to DES restenosis, because a previous report suggested that the incidence of clinical events was low and similar regardless of stent mal-apposition detected by optimal coherence tomography and/or intravascular ultrasound. 33,34 Alternatively, the extent of mal-apposition may be different between G1-DES and G2-DES in non-calcified lesions, but not in calcified lesions.…”