Yonsei Med J.  2010 May;51(3):332-338. 10.3349/ymj.2010.51.3.332.

The Initial Extent of Malapposition in ST-Elevation Myocardial Infarction Treated with Drug-Eluting Stent: The Usefulness of Optical Coherence Tomography

• Kim U
• Kim JS
• Kim JS
• Lee JM
• Son JW
• Kim J
• Ko YG
• Choi D
• Jang Y

• KMID: 1074983
• DOI: http://doi.org/10.3349/ymj.2010.51.3.332

Abstract

PURPOSE
The aim of this study is to identify the extent of initial malapposition using optical coherence tomography (OCT) in ST-elevation myocardial infarctions (STEMI) treated with different types of drug-eluting stents (DES).
MATERIALS AND METHODS
Twenty four STEMI patients that underwent primary percutaneous coronary intervention (PCI) were enrolled. The OCT and intravascular ultrasound (IVUS) were performed within 72 hours after the primary PCI. Distances between the endo-luminal surface of the strut reflection and the vessel wall and the extent of malapposition were measured and analyzed.
RESULTS
Sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES) and zotarolimus-eluting stents (ZES) were deployed in 7 patients (29%), 7 patients (29%) and 10 patients (42%). In total, 4951 struts in 620 mm single-stent segments were analyzed (1463 struts in SES, 1522 in PES, and 1966 in ZES). In strut analysis by OCT, the incidence of malapposition was 17 % (860/4951) and in stent analysis by IVUS, malapposition rate was 21% (5/24). The malapposition rate of strut level using OCT in 5 patients who had malapposition in IVUS was significantly higher than the 19 of those who had not (32 +/- 5% vs. 12 +/- 6%, p = 0.001). In addition, the frequency of malapposition was also significantly different (28% in SES, 11% in PES, 10% in ZES, p = 0.001). The use of SES was an independent predictor of malapposed struts.
CONCLUSION
The incidence of malapposition using OCT was quite prevalent in STEMI after primary PCI with DES implantation and SES has especially higher rates of malapposition compared to other DESs.

Keyword

Malapposition; drug eluting stent; coherence tomography; optical; myocardial infarction

MeSH Terms

Aged
Angioplasty, Transluminal, Percutaneous Coronary/methods
*Drug-Eluting Stents
Female
Humans
Male
Middle Aged
Myocardial Infarction/pathology/*therapy
Paclitaxel/therapeutic use
Sirolimus/analogs & derivatives/therapeutic use
Tomography, Optical Coherence/*methods

Figure

• 

  Fig. 1 Measurements of strut apposition. The distances between the endo-luminal surface of the strut reflection and the vessel wall were measured. (A and B) shows OCT image of SES and strut measurements and represents malapposition. (C and D) shows OCT image of PES and strut measurement shows normal stent apposition. (E and F) represents OCT image of ZES and its measurement shows normal stent apposition. Definition of malapposition: ≥ 160 µm for SES, ≥ 130 µm for PES, ≥ 110 µm for ZES.7 OCT, optical coherence tomography; SES, sirolimus-eluting stent; PES, paclitaxel-eluting stent; ZES, zotarolimus-eluting stent.

• 

  Fig. 2 Average distances between lumen and stent. *Represents statistical significance (p = 0.00). Definition of incomplete stent apposition: ≥ 160 µm for SES, ≥ 130 µm for PES, ≥ 110 µm for ZES. SES, sirolimus-eluting stent; PES, paclitaxel-eluting stent; ZES, zotarolimus-eluting stent.7

• 

  Fig. 3 Comparison of malapposition strut numbers according to stent. *Represents statistical significance (p = 0.00), †indicates non-significant results (p = 0.81). Definition of malapposition: ≥ 160 µm for SES, ≥ 130 µm for PES, ≥ 110 µm for ZES.7 SES, sirolimus-eluting stent; PES, paclitaxel-eluting stent; ZES, zotarolimus-eluting stent.

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