Impact of acute and persistent stent malapposition after percutaneous coronary intervention on adverse cardiovascular outcomes

Marco Lombardi, Juan G Chiabrando, Enrico Romagnoli, Domenico D'Amario, Antonio Maria Leone, Cristina Aurigemma, Rocco Antonio Montone, Alfredo Ricchiuto, Giuseppe Biondi-Zoccai, Francesco Burzotta, Ik-Kyung Jang, Javier Escaned, Carlo Trani, Italo Porto, Filippo Crea, Rocco Vergallo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Introduction: The association of coronary stent malapposition (SM) and adverse clinical outcomes after percutaneous coronary intervention (PCI) remains unclear. We aimed to perform a systematic review and meta-analysis of randomized and observational studies to assess the association between acute and persistent SM detected using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) and adverse cardiovascular outcomes. Evidence acquisition: Available studies were identified through a systematic search of PubMed, reference lists of relevant articles, and Medline. Main efficacy outcomes of interest were: device-oriented composite endpoint (DoCE, including cardiac death, myocardial infarction [MI], target lesion revascularization [TLR], and stent thrombosis [ST]), major safety events (MSE, including cardiac death, MI and ST), TLR, and ST. A sensitivity analysis regarding the impact of major malapposition was also performed. Evidence synthesis: A total of 9 studies enrolling 6497 patients were included in the meta-analysis. After a mean follow up of 24±14 months, overall acute and/or persistent malapposition was not significantly associated with the occurrence of all the outcomes of interest, including DoCE (risk ratio [RR] 1.00, 95% confidence interval [CI, 0.79-1.26], P=0.99), MSE (RR 1.42, 95%CI [0.81-2.50], P=0.22), TLR (RR 0.84, 95%CI [0.59-1.19], P=0.33), and ST (RR 1.16, 95%CI [0.48-2.85], P=0.74). In the sensitivity analysis, we found a significant increase of MSE in patients with major malapposition (RR 2.97, 95%CI [1.51-5.87], P=0.001). Conclusions: Acute and persistent SM were not overall associated with adverse cardiovascular clinical outcomes at follow-up. However, major malapposition was associated with an increased risk of major safety events, including cardiac death, MI and ST. These findings should be taken into account during stent implantation and PCI optimization.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaMinerva Cardiology and Angiology
Volume2023
DOI
Stato di pubblicazionePubblicato - 2023

Keywords

  • cardiovascular disease
  • percutaneous coronary intervention
  • stent

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