Relation between poststenting peristent plaque components and late stent malapposition after drug-eluting stent implantation: Virtual histology-intravascular ultrasound analysis

BackgroundImpact of plaque composition on late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated.MethodsWe evaluated the relation between plaque components at poststenting peristent area (between external elastic membrane and stent areas) and LSM after DES implantation in 266 patients (314 native lesions; paclitaxel-eluting stent in 205 lesions, sirolimus-eluting stent in 66 lesions, zotarolimus-eluting stent in 32 lesions and everolimus-eluting stent in 11 lesions) in whom virtual-histology intravascular ultrasound was performed at index (poststenting) and follow-up (mean: 11.7 ± 4.8 months).ResultsLSM occurred in 24 patients with 30 lesions (9.6%) and there were no significant differences in the incidences of LSM among 4 DES groups [21/205 (10.2%) in paclitaxel-eluting stent, 6/66 (9.1%) in sirolimus-eluting stent, 2/32 (6.3%) in zotarolimus-eluting stent and 1/11 (9.1%) in everolimus-eluting stent, p = 0.5)]. Patients with LSM were presented with more acute myocardial infarction (50% vs. 28%, p = 0.026) and were more diabetics (50% vs. 30%, p = 0.030) compared with those without LSM. Lesions with LSM had more poststenting peristent %necrotic core (NC) volume compared with those without LSM (25.8 ± 11.1% vs. 21.0 ± 5.7%, p < 0.001). Independent predictors of LSM were poststenting peristent %NC volume [odds ratio (OR); 1.216, 95% CI; 1.053-1.405, p = 0.008], acute myocardial infarction (OR; 2.897, 95% CI; 1.675-4.118, p = 0.029), and diabetes mellitus (OR; 2.413, 95% CI; 1.543-3.996, p = 0.038).ConclusionsPoststenting peristent NC component especially in patients with acute myocardial infarction and in those with diabetes mellitus is associated with the development of LSM after DES implantation.