Plaque Erosion Delays Vascular Healing After Drug Eluting Stent Implantation in Patients with Acute Coronary Syndrome: An In Vivo Optical Coherence Tomography Study

Objectives: To compare vascular healing after drug-eluting stent (DES) implantation between plaque rupture (PR) and plaque erosion (PE). Background: Vascular response after stent implantation in patients with PR has been extensively studied. Little is known about vascular healing after stent implantation in PE. Methods: Sixty-five ACS patients who received optical coherence tomography (OCT) imaging of the culprit lesions both before and after stent implantation at baseline as well as at 6 months were included in this study. Patients were divided into two groups: PR (n = 19) and PE (n = 24). Prestent thrombus burden and poststent intrastent structure (ISS) volume were analyzed during the index procedure. The ratio of uncovered to total stent struts per cross-section score (RUTTS) and neointimal thickness and area were measured at follow-up. Results: OCT imaging showed that compared with PR, PE showed a significantly lower prestent thrombus score (34.2 +/- 19.2 vs. 68.6 +/- 44.2, P = 0.009) at baseline and a smaller poststent ISS volume (0.7 +/- 0.9 mm(3) vs. 2.1 +/- 1.9 mm(3), P = 0.019). At the 6-month follow-up, PE showed a higher incidence of RUTTS >0.3 (12.2 +/- 14.4 vs. 2.0 +/- 4.5%, P = 0.003), thinner neointimal thickness (0.05 +/- 0.02 mm vs. 0.12 +/- 0.08 mm, P = 0.002), and smaller neointimal area (0.5 +/- 0.2 vs. 1.2 +/- 0.9 mm(2), P = 0.004) compared with PR. In a multivariate logistic model, PE was identified as an independent predictor for RUTTS >0.3. Conclusions: PE was associated with less favorable healing following DES implantation when compared to PR at 6 months, indicating longer dual-antiplatelet therapy may be necessary for patients with PE. (C) 2017 Wiley Periodicals, Inc.