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Stenting for ST-segment elevation myocardial infarction is associated with less neointimal hyperplasia in the pooled IVUS analysis from HORIZONS-AMI and the TAXUS IV and V and ATLAS workhorse, long lesion, and direct stent studies

Kobayashi, Nobuakia,b; Maehara, Akikoa,b; Allocco, Dominicc; Witzenbichler, Bernardh; Ellis, Stephen G.d; Turco, Mark A.e; Ormiston, John A.i; Guagliumi, Giulioj; Jiang, Songtaoc; McAndrew, Thomas C.b; Dawkins, Keith D.c; Stone, Gregg W.a,b; Mintz, Gary S.b; Weissman, Neil J.f,g

doi: 10.1097/MCA.0000000000000131
Original Research

Objective: To investigate the difference in neointimal hyperplasia (NIH) between ST-segment elevation myocardial infarction (STEMI), stable angina pectoris (SAP), and unstable angina pectoris (UAP).

Patients and methods: From formal core laboratory intravascular ultrasound substudies, we compared NIH after paclitaxel-eluting stents (PES) or bare metal stents (BMS) in STEMI lesions from HORIZONS-AMI trial with SAP and UAP lesions from TAXUS IV, V, and ATLAS studies.

Results: At follow-up, %NIH at the minimum lumen area (MLA) site was less in STEMI (n=212) than in UAP (n=233) and SAP (n=440) lesions treated with PES (19.6 vs. 26.2 vs. 25.0%, P=0.002; all intravascular ultrasound data shown as least-square means in abstract) and less in STEMI (n=66) than in UAP (n=72) and SAP (n=143) lesions treated with BMS (34.0 vs. 26.7 vs. 45.5%, P=0.0003). As a result, MLA at follow-up was larger in STEMI than in UAP and SAP lesions treated with PES (5.9 vs. 5.2 vs. 5.0 mm2, P<0.0001) or treated with BMS (5.1 vs. 4.3 vs. 4.0 mm2, P=0.002). Net volume obstruction ([NIH/stent volume]×100) at follow-up was significantly less in STEMI than in UAP and SAP lesions treated with PES (7.8 vs. 13.4 vs. 13.4%, P<0.0001) or BMS (20.6 vs. 28.5 vs. 32.1%, P<0.0001). Multivariate linear regression analysis showed that STEMI was correlated independently and inversely with net volume obstruction compared with SAP (regression coefficient −6.99, P<0.0001) or UAP (regression coefficient −6.29, P<0.0001).

Conclusion: Implantation of PES or BMS in STEMI compared with UAP and SAP was associated with less NIH.

aNew York Presbyterian Hospital/Columbia University Medical Center

bClinical Trials Center, Cardiovascular Research Foundation, New York, New York

cBoston Scientific Corporation, Natick, Massachusetts

dDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio

eVascular Therapies, Covidien

fGeorgetown University, Washington, District of Columbia

gMedStar Health Research Institute, Hyattsville, Maryland, USA

hAmper Kliniken AG, Dachau, Germany

iCardiology Department, Auckland City Hospital, Auckland, New Zealand

jInterventional Cardiology Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy

Correspondence to Akiko Maehara, MD, Cardiovascular Research Foundation, 12th Floor, 111 East 59th St, New York, NY 10022, USA Tel: +1 646 434 4569; fax: +1 646 434 4464; e-mail: amaehara@crf.org

Received March 13, 2014

Accepted April 28, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins