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Drug-eluting stent implantation in patients with acute coronary syndrome - The activity of platelets after inhibition and cardiovascular events: Optical Coherence Tomography (APICE OCT) study
- Source :
- Scopus-Elsevier
- Publication Year :
- 2014
-
Abstract
- Aims: To our knowledge, no randomised study has compared rates of uncovered stent struts in everolimus (EES) vs. newgeneration zotarolimuseluting (ZES-R) stents in acute coronary syndrome (ACS). The aim of our study was to evaluate the completeness of neointimal coverage with optical coherence tomography (OCT) in ACS patients treated with drug-eluting stents (DES) comparing EES versus new-generation ZES-R. Methods and results: All eligible ACS patients admitted to four Italian centres with a clinical indication for culprit lesion intervention were randomised 1:1 to EES or ZES-R. The primary study endpoint was the percentage of uncovered stent struts evaluated by optical coherence tomography (OCT) at six months. Secondary endpoints were the percentage of malapposed stent struts, percent neointimal hyperplasia crosssectional area (CSA) and major adverse cardiac events (MACE) at six months. A total of 60 patients were randomised to EES (n=29) or ZES-R (n=31). No differences were observed in baseline characteristics between the two groups. Overall, 31.7% presented with STEMI, of which 68.4% were anterior. The other patients comprised 41.7% NSTEMI and 26.7% troponin-negative ACS. A mean of 1.3±0.6 lesions were treated per patient, with a mean of 1.3±0.5 stents per lesion. At 30 days there was one sudden death. Sixmonth OCT analysis was performed in 25 lesions in the EES group and in 24 lesions in the ZES-R group. There was no difference in the primary endpoint of uncovered stent struts between groups (EES 6.42% [3.27, 9.57] vs. ZES-R 7.07% [3.22, 10.92]; p=0.80). Furthermore, there were no differences between groups in the percentage of malapposed stent struts, either with (EES 1.19% [0.34, 2.04] vs. ZES-R 0.85% [0.40, 1.30]; p=0.49) or without coverage (EES 1.06% [0.12, 2.01] vs. ZES-R 0.24% [0.05, 0.44]; p=0.09). Percent neointima CSA was similar in both groups (EES 37.0% [18.6, 55.3] vs. ZES-R 26.6% [18.4, 34.8]; p=0.31). At sixmonth clinical followup, no additional patients died or suffered MI. There were four MACE in the EES group and one in the ZES-R group. Conclusions: In our study, in patients presenting with ACS, both EES and ZES-R had low percentages of malapposed and uncovered stent struts at sixmonth OCT analysis.
- Subjects :
- Male
medicine.medical_specialty
Acute coronary syndrome
Coronary Stenosi
medicine.medical_treatment
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
Sudden death
Coronary Restenosis
Immunosuppressive Agent
Percutaneous Coronary Intervention
Coronary Restenosi
Internal medicine
Neointima
medicine
Clinical endpoint
Humans
Single-Blind Method
Sirolimu
Everolimus
cardiovascular diseases
Tomography
Coronary Vessel
Aged
Sirolimus
Neointimal hyperplasia
Optical coherence tomography
business.industry
Coronary Stenosis
Percutaneous coronary intervention
Stent
Drug-Eluting Stents
Middle Aged
medicine.disease
Coronary Vessels
Everolimu
Optical Coherence
Drug-eluting stent
Cardiology
Female
Radiology
Cardiology and Cardiovascular Medicine
business
Immunosuppressive Agents
Mace
Tomography, Optical Coherence
Acute Coronary Syndrome
Human
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Scopus-Elsevier
- Accession number :
- edsair.doi.dedup.....0bd7c3ad167923f32bf8593e76013f71