Late stent malapposition (LSM) may be acquired (LASM) or persistent. LSM may play a role in patients who develop late stent thrombosis (ST). Our objective was to compare the risk of LASM in bare... Show moreLate stent malapposition (LSM) may be acquired (LASM) or persistent. LSM may play a role in patients who develop late stent thrombosis (ST). Our objective was to compare the risk of LASM in bare metal stents (BMS) with drug-eluting stents (DES) and to investigate the possible association of both acquired and persistent LSM with (very) late ST. We searched PubMed and relevant sources from January 2002 to December 2007. Inclusion criteria were: (a) intra-vascular ultrasonography (IVUS) at both post-stent implantation and follow-up; (b) 6-9-month-follow-up IVUS; (c) implantation of either BMS or the following DES: sirolimus, paclitaxel, everolimus, or zotarolimus; and (d) follow-up for LSM. Of 33 articles retrieved for detailed evaluation, 17 met the inclusion criteria. The risk of LASM in patients with DES was four times higher compared with BMS (OR = 4.36, CI 95% 1.74-10.94) in randomized clinical trials. The risk of (very) late ST in patients with LSM (five studies) was higher compared with those without LSM (OR = 6.51, CI 95% 1.34-34.91). In our meta-analysis, the risk of LASM is strongly increased after DES implantation compared with BMS. Furthermore, LSM seems to be associated with late and very late ST. Show less
Objective: Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines.... Show moreObjective: Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, optimal timing of administration remains unclear. Our aim was to evaluate the effects of early abciximab administration in the ambulance on immediate, short and long term outcomes. Design: Single center prospective study Setting and patients: Within a fixed protocol for PPCI, December 2006 was the cut-off point for this study. 179 consecutive patients with STEMI were enrolled, 90 patients received abciximab bolus in the hospital (late group) and 89 patients received abciximab bolus in the ambulance (early group). Main outcome measures: Infarct related artery (IRA) patency pre-PPCI Results: The two groups were well matched for baseline and angiographic characteristics. The early group received abciximab within the golden period (median 63 min). The IRA patency pre-PPCI was 4 times higher in the early group than in late group (odds ratio = 4.9, 95% CI 2.4 -10.1). Enzymatic infarct size was smaller in the early group (cumulative 48-h CK release 8011 vs. 11267 U/L, p = 0.004). This was associated with higher left ventricular ejection fraction (LVEF) at 90 days post-PPCI by myocardial scintigraphy (59% vs. 54%, p = 0.01), and lower incidence of heart failure through a median of 210 days of clinical follow-up (3% vs.11%, p = 0.04). Conclusions: Early abciximab administration in the ambulance significantly improves early reperfusion in STEMI patients treated with PPCI. Moreover this is associated with a smaller infarct size, improved LV function at 3-months and a lower risk of heart failure through 7-months follow-up. Show less
