Author + information
- Received August 14, 2017
- Revision received November 1, 2017
- Accepted December 22, 2017
- Published online February 14, 2018.
- Seung-Yul Lee, MDa,
- Jung-Sun Kim, MDb,c,
- Hyuck-Jun Yoon, MDd,
- Seung-Ho Hur, MDd,
- Sang-Gon Lee, MDe,
- Jin Won Kim, MDf,
- Young Joon Hong, MDg,
- Ki-Seok Kim, MDh,
- So-Yeon Choi, MDi,
- Dong-Ho Shin, MDb,c,
- Chung-Mo Nam, PhDj,
- Byeong-Keuk Kim, MDb,c,
- Young-Guk Ko, MDb,c,
- Donghoon Choi, MDb,c,
- Yangsoo Jang, MDb,c,k and
- Myeong-Ki Hong, MDb,c,k,∗ ()
- aSanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
- bSeverance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
- cCardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- dDongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea
- eUlsan University Hospital, Ulsan, Republic of Korea
- fKorea University Guro Hospital, Seoul, Republic of Korea
- gChonnam National University Hospital, Gwangju, Republic of Korea
- hJeju National University Hospital, Jeju, Republic of Korea
- iAjou University Hospital, Suwon, Republic of Korea
- jDepartment of Preventive Medicine and Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
- kSeverance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- ↵∗Address for correspondence:
Dr. Myeong-Ki Hong, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, 03722 Seoul, Republic of Korea.
Objectives This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage.
Background Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited.
Methods A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6% uncovered) on 3-month follow-up OCT.
Results Three-month follow-up OCT data were acquired for 779 patients (87.1%). The median percentage of uncovered struts at 3 months was 8.9% and 8.2% in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009). Favorable early strut coverage (≤6% uncovered strut) was observed in 320 of 779 patients (41.1%). At 12 months, the composite event rarely occurred in the 3-month (0.3%) or 12-month (0.2%) DAPT groups (p = 0.80).
Conclusions OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups. Short-term DAPT may be feasible in selected patients with favorable early strut coverage (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of The Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus-eluting Stents Versus Biolimus A9-eluting Stents [DETECT-OCT]; NCT01752894).
This study was supported by the Cardiovascular Research Center, Seoul, Korea and funded by Abbott Vascular, Inc., Terumo Medical Corporation, and St. Jude Medical. All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Seung-Yul Lee and Jung-Sun Kim contributed equally to this paper and are joint first authors.
- Received August 14, 2017.
- Revision received November 1, 2017.
- Accepted December 22, 2017.
- 2018 American College of Cardiology Foundation
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