Comparisons of detailed arterial healing response at seven months following implantation of an everolimus- or sirolimus-eluting stent in patients with ST-segment elevation myocardial infarction

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• 作者：Takahiro Sawada ; Toshiro Shinke ; Hiromasa Otake ; Taiji Mizoguchi ; Masamichi Iwasaki ; Takuo Emoto ; Daisuke Terashita ; Takao Mizuguchi ; Hiroshi Okamoto ; Yosuke Matsuo ; Sushi-ku Kim ; Akira Takarada ; Mitsuhiro Yokoyama
• 关键词：Everolimus-eluting stent ; STEMI ; OCT ; Angioscopy
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：30 September, 2013
• 年：2013
• 卷：168
• 期：2
• 页码：960-966
• 全文大小：910 K

文摘

Background

The difference of arterial healing response following everolimus-eluting stent (EES) or sirolimus-eluting stent (SES) implantation in patients with ST-segment elevated myocardial infarction (STEMI) has not been compared in detail.

Methods

Thirty-five patients with STEMI were randomly implanted with an EES or SES (23 EES, 12 SES). At seven months, neointimal thickness (NIT) and strut malapposition were evaluated by optical coherence tomography (OCT) and the grade and heterogeneity of neointimal coverage (NIC) and development of intra-stent thrombi were evaluated by angioscopy.

Results

No significant differences were noted in clinical events experienced by the two groups, although one patient with an EES died following a papillary muscle rupture and one patient with a SES experienced sub-acute stent thrombosis. On OCT, although the EES implants showed a greater NIT than the SES implants (94.8 ¡À 88.8 ¦Ìm vs 65.6 ¡À 63.3 ¦Ìm, P < 0.0001), both the EES and SES showed an excellent suppression of neointimal proliferation in the culprit lesion of STEMI. The frequency of uncovered and malapposed struts of EES was significantly lower than that of SES (2.7 % vs. 15.7 % , P < 0.0001, 0.7 % vs. 2.3 % , P < 0.0001, respectively). The ratio of stents fully covered with neointima of EES group was significantly higher than that of SES group (P = 0.04). Angioscopic analysis also showed greater dominant NIC grade with homogenous NIC in EES than in SES (P = 0.03, P = 0.0002, respectively). The incidence of massive intra-stent thrombus of EES was lower than that of SES (P = 0.05).

Conclusion

For patients with STEMI, EES may promote better arterial healing response than SES.