Small vessel diameter and residual platelet reactivity are independent predictors
of thrombotic events after percutaneous coronary intervention (PCI). We sought to
determine whether an interaction exists between residual platelet reactivity and stent
diameter regarding the occurrence of stent thrombosis and other adverse events after
PCI. We stratified patients in the prospective ADAPT-DES registry who underwent single-lesion
PCI according to if they received a small diameter stent (SDS, defined as a stent
with a diameter of 2.25 mm). Patients receiving an SDS were compared with patients
receiving a stent ≥2.5 mm using Kaplan-Meier rates and multivariable Cox proportional
hazards regression. We defined major adverse cardiac events (MACE) as the composite
of cardiac death, myocardial infarction, and stent thrombosis (ST). Among 5,608 patients
who underwent single-lesion PCI in ADAPT-DES, 222 (4.0%) patients received an SDS.
Patients with an SDS were more likely than patients without an SDS to have 3-vessel
disease but received, on average, fewer stents and were less likely to present with
a thrombotic lesion. Receiving versus not receiving an SDS was associated with increased
risk of ST (adjusted hazard ratio 4.35, 95% confidence interval 1.95 to 9.73, p <0.001)
as well as MACE (adjusted hazard ratio 1.75, 95% confidence interval 1.11 to 2.75,
p = 0.02). There was no statistical interaction between platelet reactivity and SDS
regarding ST (p = 0.12) or MACE (p = 0.51). In conclusion, PCI with small drug-eluting
stents is associated with a high risk of thrombotic events, including ST. Further
studies should explore whether alternative treatment strategies are appropriate in
small vessels.
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Article info
Publication history
Published online: August 13, 2019
Received:
July 12,
2019
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© 2019 Elsevier Inc. All rights reserved.
