OBJECTIVE The goal of this study was to determine the impact of late-acquired stent malapposition (LASM) on long-term clinical outcomes in patients treated with coronary stent implantation. Approach and Results: We investigated major adverse cardiac event during 10 years after 6-month intravascular ultrasound examination using our previous studies database. A total of 732 patients treated with bare-metal stent (54 LASM versus 678 non-LASM) and 529 patients treated with first-generation drug-eluting stent (82 LASM versus 447 non-LASM), who did not have clinical event or censoring at the time of follow-up intravascular ultrasound, were included for the present analysis. major adverse cardiac event was defined as the composite of cardiac death, target vessel-related myocardial infarction, target lesion revascularization and stent thrombosis. Multivariable adjustment and inverse probability weight were performed to consider baseline differences. After multivariable adjustment, LASM was related to a greater risk of major adverse cardiac event (hazard ratio, 1.666 [95% CI, 1.041-2.665]; P=0.0333) and very-late stent thrombosis (hazard ratio, 3.529 [95% CI, 1.153-10.798]; P=0.0271) than non-LASM in patients treated with first-generation drug-eluting stent, but not in those treated with bare-metal stent. Results were consistent after inverse probability weight. Among patients with LASM of first-generation drug-eluting stent, no late stent thrombosis occurred in patients who continued to receive dual antiplatelet therapy. CONCLUSIONS The relationship between LASM and major adverse cardiac event might depend on the type of implanted stents during the long-term follow-up, highlighting the clinical significance of polymers and drugs in drug-eluting stent system.

中文翻译：

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冠状动脉支架植入后后期获得性支架置放不良的十年临床结果。

目的本研究的目的是确定晚期获得性支架置入不良（LASM）对冠状动脉支架置入患者长期临床结局的影响。方法和结果：我们使用先前的研究数据库，对6个月的血管内超声检查后10年内的主要不良心脏事件进行了调查。共有732例接受了裸露金属支架治疗的患者（54例LASM与678例非LAM）和529例接受第一代药物洗脱支架的患者（82例LASM与447例非LAM），但未发生临床事件或检查在本次分析中还包括了在随访中进行血管内超声检查的时间。严重的心脏不良事件定义为心脏死亡，目标血管相关性心肌梗塞，目标病变血运重建和支架血栓形成的复合物。进行多变量调整和逆概率权重以考虑基线差异。经过多变量调整后，LASM与发生严重心脏不良事件（危险比，1.666 [95％CI，1.041-2.665]； P = 0.0333）和极晚的支架血栓形成（危险比，3.529 [95％CI]）相关。 ，1.153-10.798]； P = 0.0271）在使用第一代药物洗脱支架治疗的患者中比非LASM高，但在使用裸金属支架治疗的患者中则没有。逆概率权重后的结果一致。在第一代药物洗脱支架的LASM患者中，继续接受双重抗血小板治疗的患者未发生晚期支架血栓。结论LASM与严重心脏不良事件之间的关系可能取决于长期随访期间植入支架的类型，