Author + information
- Rodrigo Souza1,
- Adriano Barbosa2,
- Marco Tulio Souza3,
- marcelo parente4,
- Bárbara Freitas Fiorin5,
- Jose Marconi Almeida Sousa6,
- Claudia Alves7,
- Adriano Caixeta8 and
- Antonio Carlos Carvalho9
- 1UNIFESP, ANANINDEUA, Pará, Brazil
- 2Hospital São Paulo, São Paulo, São Paulo, Brazil
- 3Unifesp, São Paulo, São Paulo, Brazil
- 4UNIFESP, São paulo, Brazil
- 5Royal Adelaide Hospital
- 6Complejo Hospitalario de Huelva
- 7Paulista School of Medicine, São Paulo, São Paulo, Brazil
- 8Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
Drug eluting stents (DES) have been associated with impaired coronary vasomotion and delayed re-endothelialization in proximal and distal stent segments, as opposed to bare metal stents (BMS), which may increase the risk of late stent thrombosis. Whether this phenomenon is due to the type of polymer, drug or the stent itself is still controversial. Thus, assessment of vasomotion after coronary DES implantation may be a useful surrogate marker for endothelial dysfunction and long term adverse events. We aimed to compare coronary vasomotion after implantation of a new cobalt-chromium biodegradable abluminal polymer sirolimus-eluting stent (CrCo-SES) with its counterpart bare metal stent.
Patients eligible for percutaneous coronary intervention (PCI) were recruited at São Paulo Hospital (São Paulo, Brazil), and randomly assigned to receive either CrCo-SES InpironTM or BMS Cronus SE™ (Scitech, Aparecida de Goiânia, Brazil). Exclusion criteria were the presence of diabetes mellitus, impaired renal function (creatinine clearence < 60 ml/min), infarct related-artery, cardiogenic shock, heart failure (ejection fraction < 30%), left main stenosis > 50%, complex lesions or any condition that avoided long-term dual antiplatelet therapy. Endothelial function was estimated by measuring coronary vasoreactivity in response to incremental doses of acetylcholine (Ach) infusion at 4h after index PCI and 9-month follow-up. Quantitative coronary angiography was performed offline in a dedicated software (QAngio XA, Medis, Leiden, The Netherlands) by an independent Core Lab blinded to the type of stent used. Statistical analyses were carried out in JMP software (SAS, Cary, USA) at a 2-sided alpha level of 0.05.
Twenty subjects (10 SES x 10 BMS) were included in this analysis. Baseline characteristics were similar in both groups. After higher-dose Ach infusion, there was no difference in percentage variation of proximal (BMS: -0.002 + 0.067% vs SES: -0.009 + 0.187%, p=0.040), reference (BMS: -0.030 + 0.069% vs SES: -0.022 + 0.049%, p=0.54) and distal mean diameters (BMS: -0.081 + 0.122% vs SES: 0.008 + 0.068%, p=0.06).
Unlike DES with durable polymer, this new biodagradable polymer CrCo-SES was not associated with long-term vasomotion impairment in peristent segments, as compared to its counterpart BMS.
CORONARY: Angiography and QCA