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Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy: A Randomized Trial

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Author(s)
Seung-Yul LeeJung-Sun KimHyuck-Jun YoonSeung-Ho HurSang-Gon LeeJin Won KimYoung Joon HongKi-Seok KimSo-Yeon ChoiDong-Ho ShinChung-Mo NamByeong-Keuk KimYoung-Guk KoDonghoon ChoiYangsoo JangMyeong-Ki Hong
Keimyung Author(s)
Yoon, Hyuck JunHur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
JACC. Cardiovascular Imaging
Issued Date
2018
Volume
11
Issue
12
Keyword
drug-eluting stent(s)dual antiplatelet therapyoptical coherence tomography
Abstract
OBJECTIVES:

This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage.

BACKGROUND:

Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited.

METHODS:

A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6% uncovered) on 3-month follow-up OCT.

RESULTS:

Three-month follow-up OCT data were acquired for 779 patients (87.1%). The median percentage of uncovered struts at 3 months was 8.9% and 8.2% in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009). Favorable early strut coverage (≤6% uncovered strut) was observed in 320 of 779 patients (41.1%). At 12 months, the composite event rarely occurred in the 3-month (0.3%) or 12-month (0.2%) DAPT groups (p = 0.80).

CONCLUSIONS:

OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups. Short-term DAPT may be feasible in selected patients with favorable early strut coverage (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of The Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus-eluting Stents Versus Biolimus A9-eluting Stents [DETECT-OCT]; NCT01752894).
Keimyung Author(s)(Kor)
윤혁준
허승호
Publisher
School of Medicine (의과대학)
Citation
Seung-Yul Lee et al. (2018). Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy: A Randomized Trial. JACC. Cardiovascular Imaging, 11(12), 1810–1819. doi: 10.1016/j.jcmg.2017.12.014
Type
Article
ISSN
1936-878X
Source
https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(18)30011-1
DOI
10.1016/j.jcmg.2017.12.014
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41204
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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