Comparison of vascular response between everolimus-eluting stent and bare metal stent implantation in ST-segment elevationmyocardial infarction assessed by optical coherence tomography

Abstract

Aims: The long-term safety of second-generation everolimus-eluting stents (EESs) in ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the late vascular response after stent implantation in STEMI between EES and bare-metal stent (BMS) by using optical coherence tomography (OCT). Methods and results: A prospective OCT examination was performed in 102 patients at 10 months after stent implantation for treatment of STEMI. A total of 1253 frames with 12 772 struts in 61 EESs and 776 frames with 8594 struts in 41 BMSs were analysed. There were no significant differences in the percentage of uncovered struts (2.1±2.8 vs. 1.7±2.7%, P = 0.422) and malapposed struts (0.7±1.3 vs. 0.6±1.2%, P = 0.756) between EES and BMS. The frequency of intra-stent thrombus was comparable between the two stents (13 vs. 10%, P = 0.758). The mean neointimal thicknesswas smaller in EES compared with BMS (104±39 vs. 388±148 μm, P < 0.001). In-segment binary restenosis and target lesion revascularization was less often seen in EES compared with BMS (3 vs. 17%, P = 0.028 and 2 vs. 12%, P = 0.037, respectively). Conclusion: When compared with BMS, EES showed a lower rate of stent restenosis, similar frequency of neointimal coverage, stent malapposition, and intra-stent thrombus at 10 months after stent implantation in STEMI. Our results suggest the safety and effectiveness of EES in primary percutaneous coronary intervention for STEMI patients.