Early vascular responses to everolimus-eluting cobalt–chromium stent in the culprit lesions of st-elevation myocardial infarction: results from a multicenter prospective ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-01-09

AUTHORS

Yoshihiro Morino, Daisuke Terashita, Hiromasa Otake, Tatsuo Kikuchi, Tetsuya Fusazaki, Nehiro Kuriyama, Takahide Suzuki, Yoshiaki Ito, Kiyoshi Hibi, Hiroyuki Tanaka, Shozo Ishihara, Toru Kataoka, Takashi Morita, Yoritaka Otsuka, Takatoshi Hayashi, Kengo Tanabe, Toshiro Shinke

ABSTRACT

The use of cobalt–chromium everolimus-eluting stents (CoCr-EES) for ST-segment elevation myocardial infarction (STEMI) reduces the incidence of stent thrombosis compared with bare metal stents, and a substantial difference is apparent in the initial 2 weeks. However, vascular behavior during this early period remains unclear. This was a prospective study (MECHANISM-AMI-2W) to investigate early vascular responses in STEMI patients immediately after CoCr-EES implantation and at 2-week follow-up using frequency domain-optical coherence tomography (FD-OCT). The study enrolled 52 patients (age 63.7 ± 11.7 years, male 85.0%), of whom 44 patients were available for complete serial FD-OCT analyses. Both % uncovered struts and % malapposed struts were improved at 2-week follow-up (63 ± 20 vs. 21 ± 14%, p < 0.0001 and 7.3 ± 9.0 vs. 4.7 ± 5.9%, p = 0.005, respectively). Thrombus was decreased, with significant changes in longitudinal length to stent (28.8 ± 27.7 vs. 18.1 ± 20.2%, p = 0.0001) and maximal area (0.93 ± 0.84 vs. 0.65 ± 0.63 mm2, p = 0.034). As a result, the average lumen area was significantly larger at 2 weeks (6.49 ± 1.82 vs. 6.71 ± 1.89 mm2, p = 0.048, respectively). The number of dissection flaps was lower (0.86 ± 1.11 vs. 0.52 ± 0.90%, p = 0.024). In conclusion, this study showed early vascular responses to CoCr-EES for STEMI lesions—including a significant reduction of thrombus—that resulted in lumen enlargement, earlier progression of strut coverage, and improvements in strut apposition and dissection. The combination of these factors may therefore be responsible for the safety of CoCr-EES within the initial 2 weeks. More... »

PAGES

14-24

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12928-017-0507-4

DOI

http://dx.doi.org/10.1007/s12928-017-0507-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1100270349

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29318464


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24 schema:description The use of cobalt–chromium everolimus-eluting stents (CoCr-EES) for ST-segment elevation myocardial infarction (STEMI) reduces the incidence of stent thrombosis compared with bare metal stents, and a substantial difference is apparent in the initial 2 weeks. However, vascular behavior during this early period remains unclear. This was a prospective study (MECHANISM-AMI-2W) to investigate early vascular responses in STEMI patients immediately after CoCr-EES implantation and at 2-week follow-up using frequency domain-optical coherence tomography (FD-OCT). The study enrolled 52 patients (age 63.7 ± 11.7 years, male 85.0%), of whom 44 patients were available for complete serial FD-OCT analyses. Both % uncovered struts and % malapposed struts were improved at 2-week follow-up (63 ± 20 vs. 21 ± 14%, p < 0.0001 and 7.3 ± 9.0 vs. 4.7 ± 5.9%, p = 0.005, respectively). Thrombus was decreased, with significant changes in longitudinal length to stent (28.8 ± 27.7 vs. 18.1 ± 20.2%, p = 0.0001) and maximal area (0.93 ± 0.84 vs. 0.65 ± 0.63 mm2, p = 0.034). As a result, the average lumen area was significantly larger at 2 weeks (6.49 ± 1.82 vs. 6.71 ± 1.89 mm2, p = 0.048, respectively). The number of dissection flaps was lower (0.86 ± 1.11 vs. 0.52 ± 0.90%, p = 0.024). In conclusion, this study showed early vascular responses to CoCr-EES for STEMI lesions—including a significant reduction of thrombus—that resulted in lumen enlargement, earlier progression of strut coverage, and improvements in strut apposition and dissection. The combination of these factors may therefore be responsible for the safety of CoCr-EES within the initial 2 weeks.
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32 ST-elevation myocardial infarction
33 ST-segment elevation myocardial infarction
34 STEMI patients
35 analysis
36 apposition
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38 average lumen area
39 bare metal stents
40 behavior
41 changes
42 cobalt-chromium everolimus-eluting stents
43 cobalt-chromium stent
44 coherence tomography
45 combination
46 conclusion
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49 differences
50 dissection
51 dissection flap
52 domain optical coherence tomography
53 early period
54 early progression
55 early vascular response
56 elevation myocardial infarction
57 enlargement
58 everolimus-eluting stents
59 factors
60 flap
61 frequency-domain optical coherence tomography
62 implantation
63 improvement
64 incidence
65 infarction
66 length
67 lesions
68 longitudinal length
69 lumen area
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72 metal stents
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75 optical coherence tomography study
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