BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in pr...BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).展开更多
Background： Peri-strut low-intensity area （PLIA） is a typical image pattern ofneointima detected by optical coherence tomography （OCT） after stent implantation. However, few studies evaluated the predictors and p...Background： Peri-strut low-intensity area （PLIA） is a typical image pattern ofneointima detected by optical coherence tomography （OCT） after stent implantation. However, few studies evaluated the predictors and prognosis of the PLIA; therefore, we aimed to explore the genesis and prognosis of PLIA detected by OCT in this study.Methods： Patients presenting neointimal hyperplasia documented by OCT reexamination after percutaneous coronary intervention were prospectively included from 2009 to 2011. Peri-strut intensity was analyzed and classified into two patterns： Low-intensity and high-intensity. Clinical characteristics were analyzed to assess their contribution to peri-strut intensity patterns. Follow-up were performed in patients who did not receive revascularization during OCT reexamination, and the prognosis of the patients was evaluated.Results： There were 128 patients underwent OCT reexamination after stent implantation included in the study. PLIA was detected in 22 （17.2%） patients. The incidence of PLIA was positively correlated with serum triglyceride （odds ratio [OR]： 2.11, 95% confidence interval [CI]： 1.14-3.90, P = 0.017）, low-density lipoprotein （OR： 2.61, 95% CI： 1.22-5.66, P = 0.015）, history of cerebrovascular disease （OR： 101.11, 95% CI： 6.54-1562.13, P 〈 0.001）, and initial clinical presentation of acute coronary syndrome （ACS, OR： 18.77, 95% CI： 2.73-128.83, P = 0.003） while negatively correlated with stent implantation time （OR： 0.57, 95% CI： 0.33-0.98, P = 0.043）. The median follow-up was longer than 3.8 years. Major adverse cardiovascular events （MACEs） occurred in 7 （7.3%） patients while showed no correlation with PLIA. A total of 17 （17.7%） patients experienced unstable angina （UA） and showed significant correlation with PLIA （hazard ratio： 6.16, 95% CI： 1.25-30.33, P = 0.025）.Conclusions： PLIA detected by OCT was positively correlated with higher serum lipid level, history ofcerebrovascular disease and initial presentation of ACS, and negatively correlated with stent implantation time. Patients with PLIA were more likely to have UA than those with high-intensity while no significant difference was found in MACEs.展开更多
基金funded by grants from National Natural Science Foundation of China(81100141 and 81570322 for JJ,81320108003 for JW)jointly supported by Boston Scientific
文摘BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).
文摘Background： Peri-strut low-intensity area （PLIA） is a typical image pattern ofneointima detected by optical coherence tomography （OCT） after stent implantation. However, few studies evaluated the predictors and prognosis of the PLIA; therefore, we aimed to explore the genesis and prognosis of PLIA detected by OCT in this study.Methods： Patients presenting neointimal hyperplasia documented by OCT reexamination after percutaneous coronary intervention were prospectively included from 2009 to 2011. Peri-strut intensity was analyzed and classified into two patterns： Low-intensity and high-intensity. Clinical characteristics were analyzed to assess their contribution to peri-strut intensity patterns. Follow-up were performed in patients who did not receive revascularization during OCT reexamination, and the prognosis of the patients was evaluated.Results： There were 128 patients underwent OCT reexamination after stent implantation included in the study. PLIA was detected in 22 （17.2%） patients. The incidence of PLIA was positively correlated with serum triglyceride （odds ratio [OR]： 2.11, 95% confidence interval [CI]： 1.14-3.90, P = 0.017）, low-density lipoprotein （OR： 2.61, 95% CI： 1.22-5.66, P = 0.015）, history of cerebrovascular disease （OR： 101.11, 95% CI： 6.54-1562.13, P 〈 0.001）, and initial clinical presentation of acute coronary syndrome （ACS, OR： 18.77, 95% CI： 2.73-128.83, P = 0.003） while negatively correlated with stent implantation time （OR： 0.57, 95% CI： 0.33-0.98, P = 0.043）. The median follow-up was longer than 3.8 years. Major adverse cardiovascular events （MACEs） occurred in 7 （7.3%） patients while showed no correlation with PLIA. A total of 17 （17.7%） patients experienced unstable angina （UA） and showed significant correlation with PLIA （hazard ratio： 6.16, 95% CI： 1.25-30.33, P = 0.025）.Conclusions： PLIA detected by OCT was positively correlated with higher serum lipid level, history ofcerebrovascular disease and initial presentation of ACS, and negatively correlated with stent implantation time. Patients with PLIA were more likely to have UA than those with high-intensity while no significant difference was found in MACEs.
