Frequency, mechanisms, and implications of late peri-stent contrast staining: analysis (from the HORIZONS-AMI Trial).

Autor: Yakushiji T; Columbia University Medical Center, New York, NY, USA., Inaba S, Maehara A, Brener SJ, Witzenbichler B, Guagliumi G, Brodie BR, Kellett MA Jr, Xu K, Mehran R, Mintz GS, Stone GW
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2013 Jun 01; Vol. 111 (11), pp. 1587-92. Date of Electronic Publication: 2013 Mar 13.
DOI: 10.1016/j.amjcard.2013.01.329
Abstrakt: Previous studies have suggested that angiographically detected persistent contrast staining (PSS) at follow-up may predict subsequent very late stent thrombosis. The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial was a dual-arm, factorial, randomized trial in patients with ST-segment elevation myocardial infarctions. All follow-up angiograms (1,330 lesions in 1,115 patients, median time 13.3 months) without major cardiovascular events before follow-up angiography were analyzed at a core laboratory blinded to clinical events for the presence of PSS (defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter). Corresponding follow-up intravascular ultrasound (IVUS) data (275 lesions in 248 patients) were also evaluated to assess the mechanisms of PSS. PSS was present in 23 patients (2.1%) at follow-up and was not more common with paclitaxel-eluting than with bare-metal stents. All 6 PSS patients with follow-up IVUS had stent malapposition (vs 41.2% malapposition in the follow-up IVUS cohort). Comparing poststent and follow-up IVUS, 2 patients had late acquired and 4 had persistent malapposition; all 6 showed positive vessel remodeling from baseline to follow-up (mean vessel area 22.0 ± 8.0 to 32.4 ± 11.7 mm(2), p = 0.07). During 3-year follow-up, stent thrombosis developed in no patient with PSS compared with 8 PSS-negative patients (0% vs 0.8%, p = 0.68). The rates of revascularization and major adverse cardiovascular events were also not increased in PSS patients. In conclusion, in the large-scale HORIZONS-AMI trial, PSS at angiographic follow-up was infrequent and was associated with late stent malapposition and positive remodeling but was independent of stent type. Identification of PSS was not associated with subsequent stent thrombosis.
(Copyright © 2013 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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