Cited 73 times since 2008 (6.1 per year) source: Scopus JACC. Cardiovascular interventions, Volume 1, Issue 2, 01 April 2008, Pages 192-201 Stent malapposition after sirolimus-eluting and bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: acute and 9-month intravascular ultrasound results of the MISSION! intervention study. van der Hoeven BL, Liem SS, Dijkstra J, Bergheanu SC, Putter H, Antoni ML, Atsma DE, Bootsma M, Zeppenfeld K, Jukema JW, Schalij MJ

Objectives

Acute and late stent malapposition (SM) after bare-metal stents (BMS) and sirolimus-eluting stents (SES) in ST-segment elevation myocardial infarction patients were studied.

Background

Stent thrombosis may be caused by SM after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients.

Methods

Post-procedure and follow-up intravascular ultrasound data were available in 184 out of 310 patients (60%; 104 SES, 80 BMS) included in the MISSION! Intervention Study. To determine the contribution of remodeling and changes in plaque burden to the change in lumen cross-sectional area (CSA) at SM sites, the change in lumen CSA (follow-up minus post-lumen CSA) was related to the change in external elastic membrane CSA (remodeling) and change in plaque and media CSA (plaque burden).

Results

Acute SM was found in 38.5% SES patients and 33.8% BMS patients (p = 0.51), late SM in 37.5% SES patients and 12.5% BMS patients (p < 0.001). Acquired SM was found in 25.0% SES patients and 5.0% BMS patients (p < 0.001). Predictors of acute SM were reference diameter (

Ses

odds ratio [OR] 3.49, 95% confidence interval [CI] 1.29 to 9.43;

Bms

OR 28.8, 95% CI 4.25 to 94.5) and balloon pressure (

Bms

OR 0.74, 95% CI 0.58 to 0.94). Predictors of late SM were diabetes mellitus (

Ses

OR 0.16, 95% CI 0.02 to 1.35), reference diameter (

Bms

OR 19.2, 95% CI 2.64 to 139.7), and maximum balloon pressure (

Bms

OR 0.74, 95% CI 0.55 to 1.00). Change in lumen CSA was related to change in external elastic membrane CSA (R = 0.73, 95% CI 0.62 to 0.84) after SES implantation and to change in plaque and media CSA (R = -0.62, 95% CI -0.77 to -0.46) after BMS implantation. After SES implantation, acquired SM was caused by positive remodeling in 84% and plaque reduction in 16% of patients.

Conclusions

Acute SM was common after SES and BMS stent implantation in ST-segment elevation myocardial infarction patients. After SES implantation, late acquired SM is common and generally caused by positive remodeling.

JACC Cardiovasc Interv. 2008 Apr;1(2):192-201