Early Strut Coverage and Its Implications for Dual Antiplatelet Therapy

Optical coherence tomography (OCT)-guided drug-eluting stent implantation improves early strut coverage compared with angiography-guided angioplasty. No difference was observed in terms of strut coverage between permanent-polymer everolimus-eluting stents and bioresorbable-polymer biolimus-eluting stents.

Short-term dual antiplatelet therapy may be feasible in selected patients with early strut coverage.

This study sought to measure early strut coverage in patients receiving drug-eluting stents (DES) and to explore whether the degree of coverage could be used to determine the duration of dual antiplatelet therapy.

The study randomized 894 patients to receive permanent-polymer everolimus-eluting stents (Xience) or biodegradable-polymer biolimus-eluting stents (Nobori) and to OCT-guided or angiography-guided implantation using a 2-by-2 factorial design.

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Early strut coverage was measured as the percentage of uncovered struts observed in a 3-month follow-up OCT examination.

The primary endpoint was the difference in strut coverage between stents and between OCT- and angiography-guided procedures.

The secondary endpoint was a composite of cardiac death, acute myocardial infarction, stent thrombosis, and major bleeding during the first year after the procedure in patients who had received only 3 months of dual antiplatelet therapy based on early strut coverage (≤6% uncovered struts) as observed in a 3-month follow-up OCT.

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The mean percentage of uncovered struts at 3 months was 8.9% and 8.2% with everolimus-eluting stents and biolimus-eluting stents, respectively (p = 0.69), and it was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009).

Early strut coverage was observed in 41.1% of all patients. At 1 year, the composite event rarely occurred in patients who received 3-month (0.3%) or 12-month (0.2%) dual antiplatelet therapy (p = 0.80).

Conclusion

OCT-guided angioplasty improves early strut coverage compared with angiography alone as a guide, and this difference is not altered between everolimus- and biolimus-eluting stents. Short-term dual antiplatelet therapy is feasible in patients with early strut coverage.

Original title: Early Strut Coverage in Patients Receiving Drug-Eluting Stents and Its Implications for Dual Antiplatelet Therapy: A Randomized Trial.

Reference: Seung-Yul Lee et al. J Am Coll Cardiol Img 2018, article in press.

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