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Resumen Introducción: En las guías actuales europeas para el manejo del infarto de miocardio posterior a la colocación de endoprótesis coronaria (stent), no existe consenso sobre la duración ideal de la terapia antiagregante plaquetaria dual (DAPT, dual antiplatelet therapy) para prevenir la trombosis-reestenosis del stent sin aumentar el riesgo significativo de sangrado. Objetivo: Reportar el porcentaje de sangrado mayor y de eventos cardiovasculares mayores asociados a la DAPT prolongada en pacientes atendidos en el Instituto Nacional de Cardiología y tratados con intervención coronaria percutánea primaria y stent. Métodos: Se realizó un estudio longitudinal, prospectivo observacional y descriptivo no experimental. Los pacientes fueron captados de noviembre de 2016 a diciembre de 2017. Resultados: Fueron seleccionados 135 pacientes con una media de edad de 57 ± 10 años, quienes cumplieron un seguimiento clínico por tres años. La obesidad y la hipertensión destacaron como principales factores de riesgo. Posterior al uso de DAPT durante tres años, se registró 3.7 % de mortalidad, 1.48 % de sangrado mayor y 4.4 % de trombosis-reestenosis. Conclusiones: El uso prolongado de DAPT estaría justificado por la alta incidencia de trombosis-reestenosis, sin incremento significativo en el riesgo de sangrado y con disminución de los eventos cardiovasculares mayores.
Abstract Introduction: In current European guidelines for the management of myocardial infarction after coronary stent placement, there is no consensus on dual antiplatelet therapy (DAPT) ideal duration to prevent stent thrombosis-restenosis without significantly increasing the bleeding risk. Objective: To report the percentage of major bleeding and presence of major cardiovascular events associated with prolonged DAPT in patients recruited at the National Institute of Cardiology, treated with primary percutaneous coronary intervention and stent. Methods: A longitudinal, prospective, observational, non-experimental, descriptive study was carried out. Patients were recruited from November 2016 to December 2017. Results: One-hundred and thirty-five patients with a mean age of 57 ± 10 years who completed the three-year follow-up were selected. Obesity and hypertension stood out as the main risk factors. After using DAPT for three years, 3.7% of mortality, 1.48% of major bleeding, and 4.4% of thrombosis-restenosis were recorded. Conclusions: Prolonged use of DAPT would be justified by the high incidence of thrombosis-restenosis, without a significant increase in bleeding risk, as well as a decrease in major cardiovascular events.
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Objective To explore the strategies of perioperative antithrombotic therapy in the patient undergoing revision total hip arthroplasty after coronary stent implantation. Methods The antithrombotic therapy in one patient undergoing revision total hip arthroplasty after coronary stent implantation was analyzed with the review of related literatures. Results The patient developed non-ST segment elevated myocardial infarction due to the stop of aspirin three days before operation and no low molecular weight heparin was used. The antithrombotic treatment and prevention of venous thromboembolism were analyzed. Conclusion Antithrombotic therapy should be selected reasonably in patients undergoing revision total hip arthroplasty after coronary stent implantation.
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OBJECTIVE To syste matically evaluate the prevention effects of nicorandil on contrast-induced nephropathy in patients underwent coronary angiography （CAG）or stent implantation （CSI），and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed ，Embase，Cochrane library ，Wanfang database ，CBM and CNKI ，randomized controlled trial （RCT）about nicorandil （trial group ）versus normal saline or placebo （control group ）prevented contrast-induced nephropathy in patients underwent CAG or CSI were collected during the inception to Nov. 2021. After extracting literature that met the inclusion criteria ，the bias risk assessment tool of RCT in Cochrane manual was used for quality evaluation ，and meta-analysis was performed by using RevMan 5.3 software. RESULTS A total of 17 RCTs were included ，involving 3 279 patients. Among them，there were 1 587 patients in trial group ，and 1 692 patients in control group. Results of meta-analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lo wer than control group [RR ＝0.40，95％CI（0.31，0.51）， P＜0.000 1] . Results of subgroup analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lower than control group ，whether intravenous administration [RR ＝0.47，95％CI（0.29，0.74），P＝0.001] or oral administration [RR ＝0.37，95％CI（0.28，0.50），P＜0.000 01]，whether patients with normal renal function [RR ＝0.42，95％CI（0.30， 0.59），P＜0.000 01] or with renal insufficiency [RR ＝0.38， 95％ CI（0.26，0.54），P＜0.000 01]. Scr of 24 h[SMD＝ －1.38，95％CI（－2.32，－0.44），P＝0.004]，48 h[SMD＝ －0.81，95％CI（－1.19，－0.43），P＜0.000 1] and 72 h[SMD＝ －0.24，95％CI（－0.43，－0.05），P＝0.01] after surgery in trialgroup were significantly lower than control group ；the 163.com decrease of creatinine clearance rate of 48 h[SMD＝1.27， 95％CI（0.48，2.07），P＝0.001] and 72 h[SMD＝0.37，95％CI（0.07，0.67），P＝0.02] after surgery in trial group were significantly lower than control group ；cystatin C of 24 h[SMD＝－0.93，95％CI（－1.72，－0.14），P＝0.02]，48 h[SMD＝－1.72，95％CI （－2.33，－1.10），P＜0.000 01] and 72 h[SMD＝－0.36，95％CI（－0.62，－0.10），P＝0.006] after surgery in trial group were significantly lower than control group. CONCLUSIONS Pretreatment of nicorandil can reduce the incidence of contrast-induced nephropathy in patients underwent CAG or CSI ，and reduce the damage of renal function after application of contrast.
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To explore the influence of bionic texture coronary stents on hemodynamics, a type of bioabsorbable polylactic acid coronary stents was designed, for which a finite element analysis method was used to carry out simulation analysis on blood flow field after the implantation of bionic texture stents with three different shapes (rectangle, triangle and trapezoid), thus revealing the influence of groove shape and size on hemodynamics, and identifying the optimal solution of bionic texture groove. The results showed that the influence of bionic texture grooves of different shapes and sizes on the lower wall shear stress region had a certain regularity. Specifically, the improvement effect of grooves above 0.06 mm on blood flow characteristics was poor, and the effect of grooves below 0.06 mm was good. Furthermore, the smaller the size is, the better the improvement effect is, and the 0.02 mm triangular groove had the best improvement effect. Based on the results of this study, it is expected that bionic texture stents have provided a new method for reducing in-stent restenosis.
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Bionics , Computer Simulation , Coronary Vessels , Hemodynamics/physiology , Models, Cardiovascular , Stents , Stress, MechanicalABSTRACT
Abstract Introduction: A drug-eluting coronary stent is being developed at the National Institute of Cardiology of Mexico for the treatment of ischemic heart disease. Objective: To establish the best animal model for the tests, to show the advances in the drug-eluting stent prototype, to assess two drugs antiproliferative activity and histological results. Method: Smooth muscle cell culture tests were performed in order to assess sirolimus and paclitaxel antiproliferative properties. The drugs were encapsulated inside the polymeric matrix of the stents. Rabbits and pigs were used as animal models. Results: Sirolimus and paclitaxel showed an inhibitory effect, which was higher for the latter. Infrared spectroscopy and light and optical microscopy showed that the drug/polymer layer properly adhered to the stent. At a four-week follow-up, both animal models showed satisfactory clinical evolution and adequate histological response, although the porcine model was shown to be more suitable for future protocols. Conclusions: Preliminary tests of the drug-eluting stent provided bases for the development of a study protocol with an adequate number of pigs and with clinical angiographic and histopathological three-month follow-up.
Resumen Introducción: En el Instituto Nacional de Cardiología de México se desarrolla una endoprótesis (stent) coronaria liberadora de fármacos para el tratamiento de la cardiopatía isquémica. Objetivo: Establecer el mejor modelo animal para las pruebas, mostrar los avances en el prototipo del stent liberador de fármacos, evaluar la actividad antiproliferativa de dos fármacos y los resultados histológicos. Método: Se realizaron cultivos de células de músculo liso para evaluar las propiedades antiproliferativas de sirolimus y paclitaxel. Los fármacos fueron encapsulados en el interior de la matriz polimérica de los stents. Se emplearon conejos y cerdos como modelos animales. Resultados: Sirolimus y paclitaxel mostraron efecto inhibitorio, mayor en el segundo. La espectroscopia infrarroja y la microscopia óptica y electrónica mostraron que la capa del polímero con el fármaco se adhería adecuadamente al stent. A las cuatro semanas de seguimiento, ambos modelos animales mostraron evolución clínica satisfactoria y adecuada respuesta histológica, si bien el modelo porcino resultó más conveniente para protocolos futuros. Conclusiones: Las pruebas preliminares del stent liberador de fármaco brindó bases para desarrollar el protocolo con un número adecuado en cerdos y con seguimiento clínico angiográfico e histopatológico a tres meses.
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Animals , Male , Female , Rabbits , Paclitaxel/administration & dosage , Sirolimus/administration & dosage , Drug-Eluting Stents , Prosthesis Design , Spectrophotometry, Infrared , Swine , Follow-Up Studies , Disease Models, Animal , MicroscopyABSTRACT
Objective To deduce analytic solution of the displacement and stress distributions for the coronary stent based on reasonable assumptions, and to investigate the influence from the wave number of support bars on stress distributions by combining the results of finite element analysis. Methods A local cylindrical coordinate system was established to deduce analytical solution of the displacement and stress components of the periodic support bar of the rectangular-wave type vascular stent under vascular systolic pressure. The support bar model was established by using ANSYS, to calculate the numerical results of stress analysis. By analyzing the consistency of stress curves obtained from the two methods, the accuracy and applicability of analytical solutions were verified. The influence from the number of wave crests for support bars on the stress under systolic pressure was investigated by analytic solution. Results The analytical stress curves were basically in conformity with those from the ANSYS results. When the number of wave crests was 6, there were both tensile and compressive stresses in circumferential direction of the cross bar. Conclusions When the number of wave crests was 6, such stents could effectively prevent restenosis in blood vessels during working. The derived analytical solution could be used to analyze mechanical properties of one-cycle support bars of rectangular-wave type stent, and the research findings provided a new idea to further recognize and study the stress distributions on coronary stent to reduce the restenosis rate of interventional therapy.
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Entrapment of an intravascular ultrasonography (IVUS) catheter is an infrequent but serious complication associated with percutaneous coronary intervention (PCI). We report a case of successful surgical treatment of an IVUS catheter entrapped in a coronary stent after PCI. An-80-year-old man was admitted to a hospital with sudden anterior chest pain. He underwent PCI to left circumflex branch (Cx) and left anterior descending artery (LAD), followed by IVUS to ascertain stent expansion of the LAD stent. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the LAD and directly removed the IVUS catheter with the twisted stent. The opened place in the LAD was directly closed. Additional coronary bypass grafting involving two vessels was performed. The postoperative course was uneventful with no graft occlusion.
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New biodegradable intravascular stent can reduce risk of foreign bodies retained, thus, it is widely concerned and some of the products have been introduced into the clinic. However, the characteristic of biodegradable may lead to more safety concerns associated with thrombosis. To ensure the safety, the thrombus formation experiment needs to be carefully designed and evaluated based on GB/T 16886.4 standard, but current standard do not provide explicit testing and evaluating methods. Establishing animal model with experimental pigs, the study compares biodegradable coronary stents and metal stents by simulating clinical implantation on the thrombus formation in the implanting process, and after the short-term and long-term implantation. The evaluation methods include gross observation, digital subtraction angiography intraoperative analysis, optical coherence tomography analysis, scanning electron microscopy and so on. The results show that combining these methods could comprehensively evaluate the whole process of the thrombus formation from the beginning of implantation to the end of preclinical animal experiments, so that, it may better predict the clinical thrombosis risk, and the selection of the control was very important. The study tries to use the comparison examples of thrombosis on the new medical instrument to provide the clue for thrombosis evaluation on similar instruments and show the methodology on the preclinical evaluation.
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Animals , Absorbable Implants , Drug-Eluting Stents , Polymers , Swine , Thrombosis , Tomography, Optical Coherence , Treatment OutcomeABSTRACT
The objective of this case report is to alert the cardiologists and radiologists about the possibility of an extremely rare trifurcation of the right coronary artery. During dissection classes, an early trifurcation of the right coronary artery (RCA) was observed in an adult male cadaver aged approximately 65 years. The RCA had a normal origin from the anterior aortic sinus. After a course of just 2 mm, it trifurcated into a conus artery, a huge right ventricular branch and then a main continuation of the RCA. The conus artery entered the myocardium of the conus after a short course. The huge ventricular branch had a downward and left course almost till the apex of the heart. Right marginal artery was absent. No other vascular variations of heart were observed apart from this. Knowledge of this trifurcation could be useful in coronary angioplasty and bypass procedures.
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Adult , Humans , Male , Angioplasty , Arteries , Cadaver , Conus Snail , Coronary Vessels , Heart , Myocardium , Sinus of ValsalvaABSTRACT
Objective To investigate the effect of optimizing nursing process in emergency PCI on the reduction of radiation received by interventional nurses.Methods A total of 100 cases of acute myocardial infarction patients who need emergency PCI in First Affiliated Hospital of University of South China were selected for the study,with the first 50 cases as the control group using conventional nursing process and the other 50 cases as the optimization group using the optimal nursing process in the test.Two radiation monitoring methods were used at the same time to measure,record and analyze the radiation dose to the intervention nurses in the two groups.Results The differences in radiation doses to nurses between the two groups were statistically significant in the single operation of intracoronary drug configuration,non-intracoronary drug configuration,intravenous injection,patient care,emergency material unpacking,and contrast agent replacement (Z =-5.171,-3.774,-7.208,-2.454,-4.516,-3.819,P ＜ 0.05).There was no significant difference in radiation dose to nurses between the two groups in the subcutaneous injection of drugs and vomiting care of patients (P ＞ 0.05).The difference in radiation doses to nurses between the two groups during the entire operation was statistically significant (Z =-6.105,P ＜ 0.05).Conclusions The optimized nursing process helps to reduce the radiation received by interventional nurses in emergency PCI.
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Objective To investigate the effect of aspirin and ticagrelor or clopidogrel anticoagulant therapy on platelet aggregation,endothelial function and levels of inflammatory mediators in patients with acute coro-nary syndrome(ACS)after coronary stent implantation(PCI).Methods 100 cases of patients with ACS who underwent coronary stent implantation in our hospital from April 2014 to May 2016 were enrolled in the stud-y.The patients were randomly divided into the observation group and the control group by random number ta-ble method,50 cases in each group.The observation group were treated with aspirin and ticagrelor anticoagu-lant therapy after operation,while the control group were treated with aspirin and clopidogrel anticoagulant therapy.All patients were followed up for 1 year.The platelet aggregation rate within 1 year of medication, levels of serum endothelin-1(ET-1),nitric oxide(NO),plasminogen activator inhibitor-1(PAI-1),high-sen-sitivity C reactive protein(hs-CRP),interleukin-6(IL-6)and soluble CD40 ligand(sCD40L)were compared between the two groups.The outcome events and adverse reactions were recorded.Results 1 month,6 months and 1 year after treatment,the platelet aggregation rates in the observation group were lower than those in the control group(P<0.05).After treatment,levels of serum ET-1,PAI-1,hs-CRP,IL-6 and sCD40L were sig-nificantly lower in the observation group than the control group(P<0.05),while NO level was higher than the control group(P<0.05).The incidence rates of outcome events and adverse reactions in the observation group were slightly lower than those in the control group(6.00% and 8.00% vs.10.00% and 10.00%,P>0.05).Conclusion The effect of aspirin combined with ticagrelor anticoagulant therapy is better than that of aspirin combined with clopidogrel anticoagulant therapy in patients with ACS after PCI.The former can signif-icantly improve platelet aggregation,endothelial function and levels of inflammatory mediators,and it is safe and reliable.
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Objective:To research the application value of coronary CT angiography(CTA) detection for epicardial adipose tissue(EAT) and pericardial adipose tissue(PAT) in the diagnosis of coronary stent restenosis.Method:Selected 68 cases coronary atherosclerotic stenosis patients who were treated by coronary stent from June 2012 to June 2013 in hospital. All patients were detected after the operation of CTA within 3 years and they were divided into two groups (coronary stent restenosis positive group included 29 cases, negative group included 39 cases). To analyze the relationship between EAT and PAT through the statistical method and analyze the application value of EAT and PAT in the diagnosis of coronary stent restenosis based on calcification score image measurement of EAT and PAT volume.Results: Correlation analysis results showed there was correlation between EAT volume and PAT volume (r=0.859,P<0.05); through compared CAG and the diagnostic results of coronary artery stent restenosis by EAT and PAT, the sensitivity was 82.87%, specificity was 84.62%, CCTA positive predictive value was 80.00%, negative predictive value was 86.84% and diagnostic accuracy was 83.82% of the stent patency which was evaluated by CAG. The consistency evaluation marker Kappa was 0.554. The analysis of patients with coronary stent restenosis showed that there was significant correlation between Gensini score of coronary stent restenosis and EAT and PAT(P<0.05).Conclusion:There was significant correlation between EAT volume and PAT volume, and they can be used to evaluate the sensitivity and specificity of coronary stent operation restenosis and the results were higher. Besides, its clinical diagnostic value was similar with CAG.
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Objective To investigate the myocardial protective effects of rosuvastatin in patients with unstable angina pectoris undergoing coronary stent implantation.Methods Patients (90 cases) with unstable angina pectoris undergoing coronary stent implantation in No.215 Hospital of Shanxi Nuclear Industry from January 2014 to May 2016 were divided into observation group and control group,45 cases in each group.Patients in the observation group were treated with rosuvastatin,and patients in the control group were treated with atorvastatin.The levels of CK-MB,cTnⅠ,h-FABP,hs-CRP,TNF-α,INF-γ,IL-6,IL-10,and IL-18 were compared between two groups.Adverse drug reaction and major adverse cardiac events of two groups were recorded.Results After 24 h operation,the levels of CK-MB,cTnⅠ,hs-CRP,TNF-α,INF-γ,IL-10,and IL-18 of two group were significantly higher than those before operation (P ＜ 0.05),and those in observation group were significantly lower than control group (P ＜ 0.05).There was no difference in h-FABP between two groups before and after operation (P ＜ 0.05).The level of IL-6 in the observation group after operation was higher than that before operation,but the difference was not significant (P ＜ 0.05);The level of IL-6 in the control group was significantly higher than that before operation and that of observation group (P ＜0.05);The rates of drug adverse reactions and major adverse cardiac events were similar in two groups.Conclusion Compared with same doseatorvastatin,the effects of rosuvastatin in muscle damage and inflammatory response are better,and do not increase adverse reactions.
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As the number of percutaneous coronary interventions increase annually, patients with intracoronary stents (ICS) who present for noncardiac surgery (NCS) are also on the rise. ICS is associated with stent thrombosis (STH) and requires mandatory antiplatelet therapy to prevent major adverse cardiac events. The risks of bleeding and ischemia remain significant and the management of these patients, especially in the initial year of ICS is challenging. The American College of Cardiologists guidelines on the management of patients with ICS recommend dual antiplatelet therapy (DAT) for minimal 14 days after balloon angioplasty, 30 days for bare metal stents, and 365 days for drug‑eluting stents. Postponement of elective surgery is advocated during this period, but guidelines concerning emergency NCS are ambiguous. The risk of STH and surgical bleeding needs to be assessed carefully and many factors which are implicated in STH, apart from the type of stent and the duration of DAT, need to be considered when decision to discontinue DAT is made. DAT management should be a multidisciplinary exercise and bridging therapy with shorter acting intravenous antiplatelet drugs should be contemplated whenever possible. Well conducted clinical trials are needed to establish guidelines as regards to the appropriate tests for platelet function monitoring in patients undergoing NCS while on DAT.
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Objective To analyze the relationship of the total length of coronary stent and patients’postoperative quality of life. Methods A number of 280 patients who were diagnosed as coronary artery by coronary angiography and successfully completed PCI surgery in our hospital from April 2012 to March 2013 were retrospectively collected.And they were divided into 3 groups according to the total length of the coronary stent,namely:group Ⅰ (68 cases,length of the coronary stent were less than 36 mm),group Ⅱ (156 cases,length of the coronary stent were 36 ~72 mm),and group Ⅲ (56 cases,length of the coronary stent were more than 72 mm).The prognosis and quality of life of patients of the 3 groups were compared.Results There was no significant difference in terms of in-stent restenosis,angina recurrence and target vessel revascularization rates among the 3 groups within 6 months after PCI surgery (P >0.05).But the incidence rate of adverse cardiac events of the 3 groups were significant different,and group Ⅲ were significantly higher than group Ⅱ,group Ⅱwas significantly high-er than in group Ⅰ (P 0.05).Conclusion Although the total length of coronary stent and patients’postoperative quality of life were of no correlation,it is still recommend to make assessment of vascular lesions carefully before surgery.For patients with stable disease,it is recommend to take conservative medication treatment.Make stent implan-tation only when it’s necessary and the length of coronary stent should be strictly controlled so as to reduce the incidence of adverse cardiac events.
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Objective To analyze the relationship between structure characteristics and longitudinal flexibility of the self-designed NiTi coronary stents by using finite element method. Methods A new type of stent geometric model was designed with the CAD software Soildworks, and then the finite element stent model was established with Hypermesh, MATLAB and ABAQUS software. In ABAQUS, the angular displacement loads were applied on the stent in 9 bending directions within one structural cycle to maintain the stent in a pure bending state. Results The stent flexibility appeared no significant difference before the self-contact occurred, while it showed obvious anisotropy after the self-contact occurred. In addition, the bending deformation occurred under in-plane pure bending loads, accompanied with the out-of-plane deflection and torsion deformation around the axis. Conclusions The bending behavior of the stent is determined by its structural characteristics, and the stent always shows anisotropic flexibility due to its spiral arrangement of the connecting body and self-contact, which will provide a scientific guidance for clinical application of the stent.
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Objective To analyze and compare the effects of structure parameters on synchronous motor ability between the blood vessel and stent after stent implantation by using finite element method and grey correlation theory. Methods The magnesium alloy stent of S closed-loop type was selected, and 9 models of such stents with different materials, numbers of support in circumferential direction, support lengths and initial diameters were established by using SolidWorks, and these stent models were meshed by using HyperMesh. The synchronous motor ability between the blood vessel and stent after stent implantation was simulated by using ABAQUS, and the influencing factors of different structure parameters on bending stiffness were investigated and compared by using grey correlation theory. Results The effect of materials on stent flexibility was obvious. The flexibility of magnesium alloy stent was the best, and the bending stiffness was 0.958 N•(rad•mm)-1; the best flexibility of stents were those with 5-support in circumferential direction, 1.0 mm-support length, and 1.4 mm-initial diameter, and their bending stiffness was 0.853,0.829 and 1.024 N•(rad•mm)-1, respectively. Conclusions The flexibility of magnesium alloy stent is the best, followed by stainless steel stent, and cobalt-chromium stent ranks last. With the increase of support numbers in circumferential direction, support length and initial diameter, the stent flexibility shows the decreasing tendency; the grey correlation analysis shows that the effect of materials on stent flexibility is the most significant, followed by support numbers in circumferential direction and support length, while initial diameter exerts the smallest influence. The analysis of structure parameter effects on stent flexibility will provide more scientific guidance for stent design and development as well as its intervention treatment in clinic.
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Objective To analyze whether routine prophyrlactic antibiotic administration is necessary for the patients undergoing coronary stent implantation. Methods The clinical data of 156 patients from January 2010 to December 2010 (prophylactic antibiotic therapy),and 466 patients from January 2014 to December 2014(no-prophylactic antibiotic therapy), who underwent coronary stent implantation, were retrospectively analyzed. The prophylactic antibiotics and the infection rates in two groups were compared. Results The rate of infections related to coronary stent implantation in no-prophylactic antibiotic therapy group and prophylactic antibiotic therapy group, such as surgical site infection (0.2% vs 1.3%,P>0.05) and catheter-related infection(0.6% vs 1.9%,P>0.05), was not significant different(P>0.05). Similarly, the unrelated to coronary stent implantation was not significant different, too ( P > 0. 05). Conclusion Routine prophylactic antibiotic administration is unnecessary for the patients undergoing coronary stent implantation.
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Stent entrapment is a very rare complication of percutaneous coronary intervention. The interventional approach could be a treatment strategy. However, if it does not work, surgical treatment should be considered. Here, we report a case of surgical treatment of stent entrapment in the left coronary sinus of a 53-year-old male patient.
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Humans , Male , Middle Aged , Coronary Sinus , Myocardial Infarction , Percutaneous Coronary Intervention , StentsABSTRACT
BACKGROUND/AIMS: Although drug-eluting stents (DESs) effectively reduce restenosis following percutaneous coronary intervention (PCI), they also delay re-endothelialization and impair microvascular function, resulting in adverse clinical outcomes. Endothelial progenitor cell (EPC) capturing stents, by providing a functional endothelial layer on the stent, have beneficial effects on microvascular function. However, data on coronary microvascular function in patients with EPC stents versus DESs are lacking. METHODS: Seventy-four patients who previously underwent PCI were enrolled in this study. Microvascular function was evaluated 6 months after PCI based on the index of microvascular resistance (IMR) and the coronary flow reserve (CFR). IMR was calculated as the ratio of the mean distal coronary pressure at maximal hyperemia to the inverse of the hyperemic mean transit time (hTmn). The CFR was calculated by dividing the hTmn by the baseline mean transit time. RESULTS: Twenty-one patients (age, 67.2 +/- 9.6 years; male:female, 15:6) with an EPC stent and 53 patients (age, 61.5 +/- 14.7 years; male:female, 40:13) with second-generation DESs were included in the study. There were no significant differences in the baseline clinical and angiographic characteristics of the two groups. Angiography performed 6 months postoperatively did not show significant differences in their CFR values. However, patients with the EPC stent had a significantly lower IMR than patients with second-generation DESs (median, 25.5 [interquartile range, 12.85 to 28.18] vs. 29.0 [interquartile range, 15.42 to 39.23]; p = 0.043). CONCLUSIONS: Microvascular dysfunction was significantly improved after 6 months in patients with EPC stents compared to those with DESs. The complete re-endothelialization achieved with the EPC stent may provide clinical benefits over DESs, especially in patients with microvascular dysfunction.