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- Title
Identification of Intrastent Pathology Associated With Late Stent Thrombosis Using Optical Coherence Tomography.
- Authors
Jones, Christopher R.; Khandhar, Sameer J.; Ramratnam, Mohun; Mulukutla, Suresh R.; Marroquin, Oscar C.; Althouse, Andrew D.; Rao, Anjali; Kato, Koji; Jang, Ik‐Kyung; Toma, Catalin
- Abstract
<bold>Objective: </bold>To better characterize intrastent pathology using optical coherence tomography (OCT) in patients presenting with late and very late stent thrombosis (LST/VLST).<bold>Background: </bold>The contribution of specific intrastent pathologies to the development of LST/VLST is not well understood.<bold>Methods: </bold>In this single-center, retrospective, observational study of 796 consecutive patients treated for ST-segment elevation myocardial infarction (STEMI) with primary PCI we identified 57 patients (7.2%) in whom STEMI resulted from LST/VLST. Of the patients with LST/VLST, 21 patients (37%) had OCT performed at the discretion of the operator during PCI for LST/VLST. Independent reviewers performed qualitative offline analysis of OCT images to determine the cause of stent thrombosis defined as the specific intrastent pathology associated with thrombus deposition.<bold>Results: </bold>The principal intrastent pathology causing LST/VLST was determined to be stent malapposition in 11 patients (55%), of which 5 (25% of all LST/VLST patents) had findings suggestive of positive vessel remodeling. Neoatherosclerosis was determined to be the cause of LST/VLST in 7 patients (35%). LST/VLST resulted from uncovered stent struts in 2 patients (10%). Among all LST/VLST patients, in-hospital mortality (12.3%) and post-hospital target vessel failure (TVF) or cardiac death (21.7%, median follow-up 1.6 years) remained high. There was a trend towards decreased TVF or cardiac death (7.7% vs. 27.3% P = 0.24) in patients who underwent OCT-guided therapy.<bold>Conclusions: </bold>LST/VLST remains a significant cause of STEMI and is associated with considerable morbidity and mortality. OCT use at the time of PCI consistently identifies significant intrastent pathology with potentially meaningful clinical impact.
- Subjects
UNITED States; OPTICAL coherence tomography; SURGICAL stents; THROMBOSIS; MYOCARDIAL infarction; ETIOLOGY of diseases; FOLLOW-up studies (Medicine); MYOCARDIAL infarction diagnosis; MYOCARDIAL infarction treatment; THROMBOSIS diagnosis; MEDICAL equipment; CARDIOVASCULAR system; LONGITUDINAL method; MEDICAL care; REOPERATION; RESEARCH evaluation; SURVIVAL analysis (Biometry); TIME; CORONARY restenosis; RETROSPECTIVE studies; DRUG-eluting stents; DIAGNOSIS
- Publication
Journal of Interventional Cardiology, 2015, Vol 28, Issue 5, p439
- ISSN
0896-4327
- Publication type
journal article
- DOI
10.1111/joic.12220