Impact of Positive Peri-Stent Vascular Remodeling After Sirolimus-Eluting and Paclitaxel-Eluting Stent Implantation on 5-Year Clinical Outcomes : Intravascular Ultrasound Analysis From the Poststent Optimal Stent Expansion Trial Multicenter Randomized Trial

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著者

    • KO Young-Guk
    • Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
    • SHIN Dong-Ho
    • Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
    • KIM Jung-Sun
    • Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
    • KIM Byeong-Keuk
    • Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
    • CHOI Donghoon
    • Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
    • HONG Myeong-Ki
    • Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
    • AHN Taehoon
    • Division of Cardiology, Gil Heart Center, Gachon Medical School
    • JANG Yangsoo
    • Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine

抄録

<b><i>Background:</i></b> Positive peri-stent vascular remodeling (PPVR) after drug-eluting stent (DES) implantation is an important mechanism of late-acquired stent malapposition (LASM). <b><i>Methods and Results:</i></b> A total of 226 patients (sirolimus-eluting stent [SES], n=105; paclitaxel-eluting stent [PES], n=121) from the Poststent Optimal Stent Expansion Trial who underwent a post-intervention and 9-month follow-up intravascular ultrasound were followed clinically for 5 years. PPVR was arbitrarily defined as a >10% increase in the external elastic membrane volume index at follow-up. PPVR and LASM occurred more frequently with SESs than with PESs. The 5-year rate of major adverse cardiac events was lower with SES than with PES (10.7% vs. 23.2%, P=0.002). The late and very late stent thrombosis (ST) rate was similar between the 2 DES types, but it was higher in patients with PPVR than in those without PPVR (8.8% vs. 1.3%, P=0.009) regardless of the DES type. Early discontinuation (<1 year) of dual antiplatelet therapy (DAPT; hazard ratio [HR], 24.14; 95% confidence interval [CI]: 4.90-118.87; P<0.001), PPVR (HR, 14.94; 95%CI: 1.85-120.46; P=0.011), LASM (HR, 8.01; 95%CI: 1.93-33.16; P=0.004), and stent length (HR, 1.14; 95%CI: 0.98-1.32 per mm; P=0.078) were associated with increased risk of late and very late ST. <b><i>Conclusions:</i></b> PPVR and LASM development after DES implantation, along with early discontinuation of DAPT and longer stent length, are important risk factors of late and very late ST. (<i>Circ J</i> 2012; <b>76:</b> 1102-1108)<br>

収録刊行物

  • Circulation journal : official journal of the Japanese Circulation Society

    Circulation journal : official journal of the Japanese Circulation Society 76(5), 1102-1108, 2012-04-25

    一般社団法人 日本循環器学会

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各種コード

  • NII論文ID(NAID)
    10030132280
  • NII書誌ID(NCID)
    AA11591968
  • 本文言語コード
    ENG
  • 資料種別
    ART
  • ISSN
    13469843
  • データ提供元
    CJP書誌  J-STAGE 
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