Purpose: To investigate the association of the degree of stent expansion, as assessed by optical coherence tomography (OCT), following stent implantation, and clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients. Methods: STEMI patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) OCT study were selected; Clinical outcomes were collected through 1 year. Stent expansion index is a minimum stent area (MSA) divided by average lumen area (average of proximal and distal reference lumen area). The following variables were measured: MSA (< 4.5mm2), dissection (> 200 µm in width and < 5 mm from stent segment), malapposition (> 200 µm distance of stent from vessel wall), a thrombus (area > 5% of lumen area) were compared. Results: A total of 151 patients were included; after excluding patients with suboptimal OCT quality, the population with available OCT was classified into 2 groups: under–expanded < 90% (N = 72, 51%) and well–expanded ≥ 90% (N = 67, 49%). In the well–expanded group, a significant number of the proximal vessels had a lumen area < 4.5mm2 (16.1%, p < 0.001) and a greater thrombus burden within stent (56.7%, p = 0.042). The overall 30 day and 1 year major adverse cardiovascular event (MACE) rates were 5% and 6.1%, respectively. Conclusion: Irrespective of the degree of stent expansion, the OCT findings, in STEMI patients, and the MACE at 30 days and one year follow up was low; further, well–expanded stents led to a more significant residual thrombotic burden within the stent but seemed to have insignificant clinical impact. Acknowledged stent optimization criteria, traditionally related to worse outcomes in stable patients, do not seem to be associated with worse outcomes in this STEMI population.
Bibliographical noteFunding Information:
Dr. Varbella reports personal fees from chiesi, personal fees from bayer, personal fees from astrazeneca, personal fees from daichisankyo, personal fees from boeringher, personal fees from pfizer BMS, personal fees from menarini, personal fees from servier, personal fees from Alvimedica CID, personal fees from Stentys, personal fees from Abbott vascular, grants from Sanitex, grants from Biotronik, outside the submitted work. Dr. Ando’ reports non-financial support from Terumo, during the conduct of the study; personal fees from Daiichi-Sankyo, personal fees and non-financial support from Bayer, personal fees from Pfizer-BMS, non-financial support from Boeringer-Ingelheim, personal fees from AstraZeneca, personal fees and non-financial support from Menarini, non-financial support from Abbott, non-financial support from Philips Volcano, non-financial support from Boston Scientific, outside the submitted work. Dr. Valgimigli reports grants from Medtronic, personal fees from Abbott, personal fees from Chiesi, personal fees from Bayer, personal fees from Servier, personal fees from Boeringher, personal fees from Daiichi Sankyo, outside the submitted work;
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