P3177Impact of final minimal stent area by IVUS on 1-year outcome after PCI in the SYNTAX II trial

Background: Stent malapposition is anticipated to be associated with unfavorable long-term outcomes, but data from patients treated by primary percutaneous coronary intervention (PCI) are rare.According to our previous data, stent restenosis or uncovered struts are more frequent in patients with more than 2% malapposed struts in baseline analysis.Purpose: To evaluate association of baseline stent malapposition to death, myocardial infarction or target vessel revascularization in six-year follow-up.Methods: 105 patients with acute ST segment elevation myocardial infarction underwent OCT guided primary PCI.In 100 of these patients the OCT record was eligible for malapposition analysis.Either biolimus A9 or everolimus eluting stents were used in the trail.The OCT study was performed with C7-XRTM intravascular imaging system employing a non-occlusive technique.It was intended to maintain complete stent apposition, if feasible.Subsequent offline pullback analysis was performed using OCTivat-Stent software.Data in groups were compared by logrank test.Results: Mean follow-up was 6.3 (5.2 -7.8 years).More than 2% of malapposed struts were present in 13 (13%) of study patients.Of these patients, 1 (7.7%) patient died, 1 suffered myocardial infarction and 3 (23.1%)patients underwent target lesion revascularization.In patients with <2% of malapposed struts, 5 (5.7%) died, 2 (2.3%) suffered myocardial infarction and 4 (4.6%)underwent target lesion revascularization (p<0.01 for combined endpoint of death, myocardial infarction and target lesion revascularization). Conclusion:Stent malapposition is associated with unfavorable results in longterm follow-up in patients treated by primary coronary angioplasty.