Early Strut Coverage in Patients ReceivingDrug-Eluting Stents and its Implicationsfor Dual Antiplatelet Therapy

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 ¼ 444) or biolimus-eluting stent (BES) (n ¼ 450) groups and optical coherence tomography (OCT)-guided (n ¼ 445) or angiography-guided (n ¼ 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 ¼ 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p ¼ 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 ¼ 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) (J Am Coll Cardiol Img 2018;11:1810–9)