－S 227 －
― F-209 ―
The Finding of Drug-Eluting Stent using Optical Coherence Tomography in ST-elevation Myocardial Infarction at 9 Month After Stent Implantation.
연세대학교 의과대학 심장혈관병원 심장내과
*김재덕, 이정명, 김진선, 홍성진, 김웅, 김중선, 고영국, 최동훈, 장양수, 정남식
Background: In the patients underwent coronary stent implantation, neointimal coverage of stent struts is clinically important because incomplete stent coverage might be related to late stent thrombosis. Optical coherence tomography (OCT) could detect a thin layer of neointimal hyperplasia (NIH) and malapposition with high-resolution. We compared neointimal hyperplasia, stent exposure and malapposition at 9 months after implantation of sirolimus eluting stent (SES) or zotarolimus eluting stent (ZES) in ST elevation myocardial infarction (STEMI) patients using optical coherence tomography. Method: OCT was performed at 9-months follow-up to examine 19 STEMI patients (7 SESs and 12 ZESs). NIH thickness inside each strut, percent NIH area in each cross section and stent apposition were evaluated. Results:
In total, 4541 struts in 401-mm single-stented segments were analyzed. Mean NIH thickness was significantly thicker in patients with ZESs than the patients with SESs (SES vs. ZES: 6.7±5.6 μm vs. 25.9±9.1 μm, p < 0.001). Percentage of NIH area was also significantly different between SESs and ZESs (10.0±9.4% vs. 29.2±8.8%, p<0.001). In SESs, there were remarkably higher proportion of exposed struts (20.1%
vs. 0.7%), and malapposed struts (6.5% vs. 0.03%) than in ZESs. Thrombus was also more frequently seen in SESs than ZESs (71.4% vs.
33.3%)Conclusion: Neointimal coverage at 9-month after stent implantation was nearly complete in ZESs but exposed and malapposed struts were more frequently observed in SESs. This study suggests that 9 month-maintenance of dual antiplatelet therapy might be enough for patients with ZESs even in STEMI.
― F-210 ―
Comparison of long-term outcomes between the sirolimus and the paclitaxel drug eluting stents in diabetic patients and/or non diabetic populations
서울대학교병원 순환기내과
*최동현, 조영진, 민희석, 박경우, 이해영, 박진식, 강현재, 구본권, 오병희, 박영배, 김효수
Introduction: It remains still controversial whether the degree of effectiveness provided by sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) is similar in patients with diabetes and/or non diabetic populations. We investigated the long-term clinical outcomes of SES and PES in DES cohort of Seoul National University Hospital. Methods: In this study, total 1790 patients (mean age 64꼉10ys) who underwent PCI with drug eluting stent (DES) between February 2003 and June 2006, were analyzed. We investigated the clinical outcomes of 666 diabetic subgroup patients treated with either SES (n=446), or PES(n=220), and of 1124 non diabetic group patients (SES 766, PES 358).
Results: The rate of major adverse cardiac events (MACE) in diabetic patients during mean follow up duration of 21.8꼉12.1 months (median 20.9 months), was similar between SES and PES (SES vs. PES; 21.7% vs. 22.3%, P = 0.878). The rate of target vessel revascularization (TVR) in diabetic patients was lower in SES group (SES vs. PES; 12.8% vs. 19.1%, P = 0.031, OR = 0.669, CI 0.465-0.964). However, the rate of MACE in non diabetic patients was significantly lower in SES group than in PES group (SES vs. PES; 11.4% vs. 17.0%, P = 0.009, OR = 0.667, CI 0.493-0.902). In a different aspect, the rate of MACE in SES group was significantly higher in diabetic group than in non diabetic group (21.7% vs. 11.4%, P < 0.001, RR = 1.915, CI 1.469-2.495) due to differences in cardiac death (5.6% vs. 1.8%, P < 0.001, RR = 3.067, CI 1.611-5.838) but the rate of MACE in PES group was not different between diabetics and non diabetic group (22.3% vs.
17.0%, P = 0.12). Conclusions: The rate of MACE in non diabetic patients was significantly lower in SES group than in PES group. But the rate of MACE in diabetic patients was similar between SES and PES. It means that the superiority of SES in non diabetic group is attenuated in diabetics. In SES group, the rate of MACE was higher in diabetics than non diabetic group. In PES group, however, the rate of MACE was similar between diabetics and non diabetic group. These data suggest that PES is durable in diabetics.
