Delayed Arterial Healing and Increased Late Stent Thrombosis at Culprit Sites After Drug-Eluting Stent Placement for Acute Myocardial Infarction Patients

Abstract

Background-The long-term safety of drug-eluting stents (DES) for acute myocardial infarction (AMI) remains uncertain.Using autopsy data, we evaluated the pathological responses of the stented segment in patients treated with DES for AMI and compared with patients with stable angina. Methods and Results-From the CVPath Registry of 138 DES autopsies, we identified 25 patients who presented with AMI and had an underlying necrotic core with a ruptured fibrous cap. Twenty-six patients who had stable angina with thick-cap fibroatheroma treated by DES were selected as controls. Histomorphometric analysis was performed in patients with Ͼ30-day stent duration. We compared the response to stenting at the culprit site in these 2 groups and to nonculprit sites within each stent.

Clinical outcomes in patients with ST-segment elevation myocardial infarction treated with everolimus-eluting stents versus bare-metal stents (EXAMINATION): 5-year results of a randomised trial

“…Specifi cally, the mean rate of uncovered stents seemed to be as high as 49% in culprit lesions from patients with ST-elevation myocardial infarction, compared with 9% in stable plaques after sirolimuseluting stent implantation. 11 In this clinical context, long-term presence of a durable polymer has been proposed as a point of origin for a chronic infl ammatory response that might delay the healing process. 12 Therefore, research in this fi eld has been redirected toward biodegradable polymer-based metallic DES, polymer-free DES, or completely bioresorbable scaff olds.…”

“…2 In this clinical setting, fi rst-generation drug-eluting stents (DES) reduced clinical and angiographic restenosis, compared with bare-metal stents (BMS). [3][4][5][6][7] Conversely, these benefi ts were counterbalanced by an increased risk of very late stent thrombosis, [8][9][10][11] safety concerns that were confi rmed on autopsy, and intravascular imaging studies showing evidence of incomplete endothelialisation, delayed arterial healing, and vessel remodelling because of chronic infl ammation. [12][13][14][15] The development of neotherosclerosis, 16 which might occur earlier after DES than after BMS, 17 has also been identifi ed as a potential cause.…”

Comparison of biolimus eluted from an erodible stent coating with bare metal stents in acute ST-elevation myocardial infarction (COMFORTABLE AMI trial): rationale and design

“…Notwithstanding, there remains a nagging concern regarding the safety of DES in STEMI patients particularly during long-term follow-up. Histopathologic analysis of autopsy specimens revealed more inflammation, fibrin deposition and uncovered struts among lesions treated with early generation DES in patients with acute MI compared to those with stable lesions, suggesting a differential healing response depending on underlying plaque morphology 9,10 . Similar observations were obtained in intravascular imaging studies 10,11 .…”

Clinical Implications of Circulating Microbiome in Cardiovascular Disease Patients

“…Drug eluting stents which were earlier a source of external infection have been used to overcome the problem of restenosis and thrombosis, as they inhibit vascular smooth cell proliferation and regrowth of the endothelium [19]. Of late, bio-absorbable stents were developed and used widely after successful completion of the first clinical studies [20].…”