Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: Optical coherence tomography substudy of the harmonizing outcomes with revascularization and stents in acute myocardial infarction (HORIZONS-AMI) trial

Giulio Guagliumi, Marco A. Costa, Vasile Sirbu, Giuseppe Musumeci, Hiram G. Bezerra, Nobuaki Suzuki, Aleksandre Matiashvili, Nikoloz Lortkipanidze, Laurian Mihalcsik, Antonio Trivisonno, Orazio Valsecchi, Gary S. Mintz, Ovidiu Dressler, Helen Parise, Akiko Maehara, Ecaterina Cristea, Alexandra J. Lansky, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

152 Scopus citations

Abstract

Background- The safety of drug-eluting stents in ST-segment elevation myocardial infarction (STEMI) continues to be debated. Pathological studies have demonstrated an association between uncovered struts and subsequent stent thrombosis. Optical coherence tomography can detect stent strut coverage in vivo on a micron-scale level. We therefore used optical coherence tomography to examine strut coverage in patients with STEMI treated with paclitaxel-eluting stents (PES) and bare metal stents (BMS). Methods and Results- In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, patients with STEMI were randomized 3:1 to PES or BMS implantation. In a formal substudy, optical coherence tomography at 13 months was performed in 118 consecutive randomized patients (89 PES, 29 BMS) in whom 188 stents were assessed (146 PES and 42 BMS). A total of 44 139 stent struts were analyzed by an independent core laboratory blinded to stent assignment. The primary prespecified end point, the percentage of uncovered stent struts per lesion at follow-up, was 1.1±2.5% in BMS lesions versus 5.7±7.0% in PES lesions (P<0.0001). Malapposed struts were observed in 0.1±0.2% of BMS lesions versus 0.9±2.1% of PES lesions (P=0.0003). Percentage net volume obstruction was 36.0±15.4% with BMS and 19.2±11.3% with PES (P<0.0001). Conclusions- In patients with STEMI undergoing primary percutaneous coronary intervention, implantation of PES as compared with BMS significantly reduces neointimal hyperplasia but results in higher rates of uncovered and malapposed stent struts as assessed by optical coherence tomography at 13-month follow-up. Further studies are required to determine the clinical significance of these findings. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

Original languageEnglish
Pages (from-to)274-281
Number of pages8
JournalCirculation
Volume123
Issue number3
DOIs
StatePublished - 25 Jan 2011
Externally publishedYes

Keywords

  • angioplasty
  • myocardial infarction
  • stents
  • thrombosis
  • tomography, optical coherence

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