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European Heart Journal Advance Access published online on January 21, 2009
European Heart Journal, doi:10.1093/eurheartj/ehn553
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Late stent malapposition risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis

Ayman K.M. Hassan1,2, Sandrin C. Bergheanu1,3,4, Theo Stijnen5, Bas L. van der Hoeven1, Jaapjan D. Snoep3, Josepha W.M. Plevier6, Martin J. Schalij1 and J. Wouter Jukema1,*

1 Department of Cardiology C5-P, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
2 Department of Cardiology, Assiut University, Assiut, Egypt
3 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
4 Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
5 Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
6 Information Specialist Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands

Received 13 June 2008; revised 17 September 2008; accepted 19 November 2008.

* Corresponding author. Tel: +31 71 526 6695, Fax: +31 71 526 6885, Email: j.w.jukema{at}lumc.nl

Aims: Late stent malapposition (LSM) may be acquired (LASM) or persistent. LSM may play a role in patients who develop late stent thrombosis (ST). Our objective was to compare the risk of LASM in bare metal stents (BMS) with drug-eluting stents (DES) and to investigate the possible association of both acquired and persistent LSM with (very) late ST.

Methods and results: We searched PubMed and relevant sources from January 2002 to December 2007. Inclusion criteria were: (a) intra-vascular ultrasonography (IVUS) at both post-stent implantation and follow-up; (b) 6–9-month-follow-up IVUS; (c) implantation of either BMS or the following DES: sirolimus, paclitaxel, everolimus, or zotarolimus; and (d) follow-up for LSM. Of 33 articles retrieved for detailed evaluation, 17 met the inclusion criteria. The risk of LASM in patients with DES was four times higher compared with BMS (OR = 4.36, CI 95% 1.74–10.94) in randomized clinical trials. The risk of (very) late ST in patients with LSM (five studies) was higher compared with those without LSM (OR = 6.51, CI 95% 1.34–34.91).

Conclusion: In our meta-analysis, the risk of LASM is strongly increased after DES implantation compared with BMS. Furthermore, LSM seems to be associated with late and very late ST.

Key Words: Meta-analysis • Late stent malapposition • Late stent thrombosis • Drug-eluting stents


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