Impact of tissue prolapse after stent implantation on short- and long-term clinical outcomes in patients with acute myocardial infarction: An intravascular ultrasound analysis

Background: We used intravascular ultrasound (IVUS) to evaluate the association of tissue prolapse (TP) with short- and long-term outcomes after stent implantation in 418 acute myocardial infarction (AMI) patients. Methods: We evaluated the incidences of stent thrombosis, no-reflow, and long-term outcomes between patients with TP (n = 142) and those without TP (n = 276). Results: twb.42w?>Acute and subacute stent thromboses occurred more frequently in patients with TP compared with those without TP (3.5% vs. 0.7%, p = 0.035, and 4.2% vs. 0.7%, p = 0.013, respectively). TP volumes in 14 patients with stent thrombosis were significantly greater than those in 128 patients without stent thrombosis (3.3 ± 1.6 mm3 vs. 2.6 ± 1.9 mm3, p = 0.012). No-reflow was developed more frequently in patients with TP compared with those without TP (25.4% vs. 9.8%, p < 0.001). Creatine kinase-MB and cardiac-specific troponin I were elevated more significantly after stenting in patients with TP compared with those without TP (Δ = + 9.0 ± 25.2 U/l vs. ―4.2 ± 41.6 U/l, p = 0.001 and Δ = + 10.0 ± 43.5 ng/ml vs. ―1.2 ± 35.6 ng/ml, p = 0.005, respectively). There were no significant differences in the incidences of cardiac death, MI, and target vessel revascularization at 1-year. Multivariate analysis showed that TP was the independent predictor of composite of acute and subacute stent thromboses [odds ratio (OR) = 4.211; 95% CI 1.198―14.805, p = 0.025] and composite of acute stent thrombosis and no-reflow (OR = 2.551: 95% CI 1.315―4.952, p = 0.006). Conclusions: TP was associated with poor short-term outcomes (more acute and subacute thromboses and no-reflow phenomenon), however it was not associated with worse long-term outcomes after stent implantation for infarct-related arteries in patients with AMI.