Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy: A Randomized Trial

Seung Yul Lee, Jung Sun Kim, Hyuck Jun Yoon, Seung Ho Hur, Sang Gon Lee, Jin Won Kim, Young Joon Hong, Ki Seok Kim, So Yeon Choi, Dong Ho Shin, Chung Mo Nam, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong Ki Hong

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33 Citations (Scopus)


Objectives: This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage. Background: Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited. Methods: A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6% uncovered) on 3-month follow-up OCT. Results: Three-month follow-up OCT data were acquired for 779 patients (87.1%). The median percentage of uncovered struts at 3 months was 8.9% and 8.2% in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009). Favorable early strut coverage (≤6% uncovered strut) was observed in 320 of 779 patients (41.1%). At 12 months, the composite event rarely occurred in the 3-month (0.3%) or 12-month (0.2%) DAPT groups (p = 0.80). Conclusions: OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups.

Original languageEnglish
Pages (from-to)1810-1819
Number of pages10
JournalJACC: Cardiovascular Imaging
Issue number12
Publication statusPublished - 2018 Dec

Bibliographical note

Funding Information:
This study was supported by the Cardiovascular Research Center, Seoul, Korea and funded by Abbott Vascular, Inc., Terumo Medical Corporation, and St. Jude Medical. All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Seung-Yul Lee and Jung-Sun Kim contributed equally to this paper and are joint first authors.

Publisher Copyright:
© 2018 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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