Background and objectives Acute and late stent malapposition (SM) after drug-eluting stent (DES) implantation may lead to stent thrombosis and other adverse clinical outcomes. The purpose of this study was to investigate the incidence and predictors of acute and late SM in acute myocardial infarction (AMI) patients treated with the second generation DES such as everolimus- or zotalorimus-eluting stents.
Methods The efficacy and safety of EVERolimus-eluting versus ZOTArolimus-eluting stent for coronary lesions in acute myocardial infarction (EVERZOTA) trial was a muticenter, prospective, randomized trial comparing everlorimus-eluting stents (EES) and zotarolimus-eluting stents(ZES) in AMI patients. The intravascular ultrasound (IVUS) was analyzed in 71 native infarct-related coronary lesions (33 EES, 38 ZES) at baseline and 9-month follow-up.
Results Postintervention acute SM occurred in 9% EES- and 13.1% ZES-treated lesions. Of these, 66.7% EES- and 40% ZES-treated lesions resolved at follow-up. A higher frequency of late SM was detected in ZES-treated lesions mainly because of more late acquired SM (72.7%) compared with EES-treated lesions at follow-up (28.9% vs. 3%, p=0.004). Presence of severe calcification, angiographicaly large thrombus burden, plaque/thrombus protrusion on IVUS, use of thrombectomy, and glycoprotein IIb-IIIa inhibitor, were not associated with late acquired SM. ZES use was an only independent predictor of late acquired SM (odds ratio, 13.04; 95% CI 1.580-107.556).
Conclusions The incidence of acute and late SM was quite lower in EES- and ZES-treated lesions, but late acquired SM was more common in ZES-treated lesions. EES seems to be superior to ZES in the treatment of AMI in terms of low occurrence of late acquired SM.