Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE Study

• Published in: Heart (British Cardiac Society) Vol. 97; no. 22; pp. 1841 - 1846
• Main Authors: Prati, Francesco, Stazi, Filippo, Dutary, Jaime, La Manna, Alessio, Di Giorgio, Alessandro, Pawlosky, Tomasz, Gonzalo, Nieves, Di Salvo, Maria Elena, Imola, Fabrizio, Tamburino, Corrado, Albertucci, Mario, Alfonso, Fernando
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.11.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Catheters; Chromium Alloys - therapeutic use; Coronary Restenosis - prevention & control; Diseases of the cardiovascular system; Drug-Eluting Stents; European Union; Female; Heart attacks; Humans; Male; Medical imaging; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; optical coherence tomography; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; Risk Factors; Stent; Stents; Tomography, Optical Coherence; Treatment Outcome; vessel healing; Wound Healing; Endoprosthesis; Radiodiagnosis; Angioplasty; Instrumentation therapy; Instrumental dilatation; Medical screening; Generation; Healing agent; Coherence; Primary; Chromium; Tomography; Early; Circulatory system; Cardiology; Detection; Cicatrization; Drug eluting stent
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2011-300782

BackgroundLack of stent coverage appears to be associated with stent thrombosis, a problem of particular concern in patients with ST elevation myocardial infarction (STEMI).MethodsThe DETECTIVE European Multicenter Registry was set up to address the early modality of stent healing in the setting of STEMI. The Registry compared, with an early optical coherence tomography (OCT) evaluation performed at 3–7 days, the patterns of coverage and apposition of the first generation of drug-eluting stents (DESs) and cobalt chromium non-drug-eluting stents (CCSs) that were deployed in culprit lesions and in non-culprit segments. The Registry included only patients with a multi-vessel disease to allow, at 3–7 days from the first angioplasty, a deferred OCT examination and a staged intervention in another vessel.Results28 stented lesions (15 patients) eventually entered the final OCT assessment. 13 stents were first-generation DESs, while the remaining 15 were CCSs. 18 stents (64%) were deployed at culprit STEMI lesions, and the remaining 10 (36%) were deployed at non-culprit sites. The distribution of clinical and procedural variables in DES and CCS as well as in culprit and non-culprit sites was not different. In total, 27 019 struts were analysed in 28 stents. The percentage of stent uncoverage in the overall analysis was 11.7%, while the percentage of malapposition and that of struts covered with thrombus were 4.8% and 2.2%, respectively. A low percentage of strut uncoverage was found in all the four studied subgroups: DES 12.8%, CCS 10.9%, stents deployed in culprit lesions 13.2% and stents deployed in non-culprit lesions 8.7%.ConclusionsIn conclusion, our data show that in patients with STEMI, a very high percentage of stent struts is covered by an early thin rim of tissue within 7 days after stent positioning. The present data bring new insights in the mechanism and timing of strut coverage.