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Interventional cardiology
Impact of late incomplete stent apposition after sirolimus-eluting stent implantation on 4-year clinical events: intravascular ultrasound analysis from the multicentre, randomised, RAVEL, E-SIRIUS and SIRIUS trials
  1. R Hoffmann1,
  2. M-C Morice2,
  3. J W Moses3,
  4. P J Fitzgerald4,
  5. L Mauri5,
  6. G Breithardt6,
  7. J Schofer7,
  8. P W Serruys8,
  9. H-P Stoll9,
  10. M B Leon3
  1. 1
    University Hospital Aachen, Aachen, Germany
  2. 2
    Institute Cardiovasculaire Paris-Sud, Massy, France
  3. 3
    Columbia University Medical Center, New York, USA
  4. 4
    Stanford University, Stanford, USA
  5. 5
    Brigham and Women’s Hospital Harvard Medical School, Boston, MA, USA
  6. 6
    Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany
  7. 7
    Centre for Cardiology and Vascular Intervention, Hamburg, Germany
  8. 8
    Erasmus Medical Centre, Rotterdam, The Netherlands
  9. 9
    Cordis Clinical Research, Waterloo, Belgium
  1. Dr R Hoffmann, Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, D-52057 Aachen, Germany; RHoffmann{at}


Background: The impact of incomplete stent apposition (ISA) after drug-eluting stent implantation determined by intravascular ultrasound (IVUS) on late clinical events is not well defined.

Objective: To evaluate the clinical impact of ISA after sirolimus-eluting stent (SES) placement during a follow-up period of 4 years.

Design: Pooled analysis from the RAVEL, E-SIRIUS and SIRIUS trials, three randomised, multicentre studies comparing SES and bare-metal stents (BMS).

Methods: IVUS at angiographic follow-up was available in 325 patients (SES: n = 180, BMS: n = 145). IVUS images were reviewed for the presence of ISA defined as one or more unapposed stent struts. Clinical follow-up was available for a 4-year period in all patients. Frequency, predictors and clinical sequel of ISA at follow-up after SES and BMS implantation were determined.

Results: ISA at follow-up was more common after SES (n = 45 (25%)) than after BMS (n = 12 (8.3%), p<0.001). Canadian Cardiology Society class III or IV angina at stent implantation (odds ratio (OR) = 4.69, 95% CI 2.15 to 10.23, p<0.001) and absence of diabetes (OR = 3.42, 95% CI 1.05 to 11.1, p = 0.041) were predictors of ISA at follow-up after SES placement. Rate of myocardial infarction tended to be slightly higher for ISA than for non-ISA patients. When SES patients only were considered, major adverse cardiac event free survival at 4 years was identical for those with and without ISA at follow-up (11.1% vs 16.3%, p = 0.48).

Conclusions: ISA at follow-up is more common after SES implantation than after BMS implantation. Considering the current very sensitive IVUS definition, ISA appears to be an IVUS finding without significant impact on the incidence of major adverse cardiac events even during long-term follow-up.

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  • Competing interests: All authors of the manuscript have received from Cordis, NJ, USA either reimbursement for attending a symposium, a fee for speaking, a fee for organising education, funds for research or fees for consulting within the past 5 years.

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