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Early and Mid-Term Vascular Responses to Optical Coherence Tomography-Guided Everolimus-Eluting Stent Implantation in Stable Coronary Artery Disease.

Kobe University Graduate School of Medicine, Kobe, Japan; Showa University School of Medicine, Tokyo, Japan. Electronic address: shinke@med.showa-u.ac.jp. Iwate Medical University, Morioka, Japan. Kobe University Graduate School of Medicine, Kobe, Japan. Edogawa Hospital, Tokyo, Japan. Yamaguchi University Graduate School of Medicine, Ube, Japan. Osaka General Medical Center, Osaka, Japan. Himeji Cardiovascular Center, Himeji, Japan. Kobe University Graduate School of Medicine, Kobe, Japan; Himeji Cardiovascular Center, Himeji, Japan. Awaji Medical Center, Sumoto, Japan. Akashi Medical Center, Akashi, Japan. Osaka Saiseikai Nakatsu Hospital, Osaka, Japan. Bell Land General Hospital, Sakai, Japan. Yokohama City University Medical Center, Yokohama, Japan. Mimihara General Hospital, Sakai, Japan. Wakayama Medical University, Wakayama, Japan. University of Occupational and Environmental Health, Kitakyushu, Japan. Hokkaido Social Insurance Hospital, Sapporo, Japan. Miyazaki Medical Association Hospital, Miyazaki, Japan. Kobe Red Cross Hospital, Kobe, Japan. Yodogawa Christian Hospital, Osaka, Japan. Ako City Hospital, Ako, Japan. Fukuoka Wajiro Hospital, Fukuoka, Japan.

The Canadian journal of cardiology. 2019;(11):1513-1522
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Abstract

BACKGROUND Analysis of pooled clinical data has shown the safety of 3 months of dual antiplatelet therapy with everolimus-eluting cobalt-chromium stents (Co-Cr EESs). This study evaluated early and mid-term vascular responses to Co-Cr EESs in patients with stable coronary artery disease. METHODS The Multicenter Comparison of Early and Late Vascular Responses to Everolimus-Eluting Cobalt-Chromium Stent and Platelet Aggregation Studies in Patients With Stable Angina Managed as Elective Case (MECHANISM-Elective) study (NCT02014818) is a multicenter optical coherence tomography (OCT) registry. Enrolled patients were evaluated by OCT immediately after everolimus-eluting stent implantation were prospectively allocated to 1 month (n = 50) or 3 months (n = 50) OCT follow-up and then received a 12-month OCT evaluation. The incidences of intrastent thrombus (IS-Th) and irregular protrusion (IRP) were also assessed. RESULTS The percentage of uncovered struts was 6.4% ± 10.3% at 1 month (P < 0.001 vs. postprocedure) and 0.5% ± 0.9% at 12 months (P < 0.001 vs. 1 month). The corresponding values in the 3-month cohort were 2.0% ± 2.5% (P < 0.001 vs. postprocedure) and 0.5% ± 1.5% (P < 0.001 vs. 3 months). The incidence of IS-Th was 32.7% at 1 month, 5.4% at 3 months, and 2.0% at 12 months. IRP was observed in 21.8% of patients post-EES but had totally resolved at 1, 3, and 12 months. CONCLUSION Early and mid-term vascular reactions after Co-Cr EES implantation in stable patients with coronary artery disease in the MECHANISM-Elective included dynamic resolution of IS-Th and IRP and rapid decrease in uncovered struts. Thus, EES may allow shortening of dual antiplatelet therapy duration less than 3 months in this patient subset.

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