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Head-to-head comparison of sirolimus-eluting stent vs. bare metal stent: Evaluation of the coronary endothelial dysfunction in the same patient presenting with multiple coronary artery lesions.
MedLine Citation:
PMID:  23359371     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: to assess the endothelial dysfunction (ED) after bare metal stents (BMS) and sirolimus eluting stents (SES) implantation in the same patient, overcoming the confounding role of individual variables. BACKGROUND: SES reduce restenosis rate compared to BMS but cause more ED. ED is a potentially unsafe phenomenon, since it is the first step in the cascade of atherosclerosis. Studies showing more pronounced ED with drug eluting stents than BMS involved different series of patients, making the comparison difficult because endothelial function (EF) is responsive to many risk factors. METHODS: we designed a prospective comparison of 6 months post-deployment EF of SES vs. BMS implanted in the same patient, but in different coronary segments. Forty-eight lesions were randomly assigned on a 1:1 allocation using block sizing of 4 according to a computer-generated sequence (SAS System, Version 9.1) basis to treatment with SES or BMS. The EF was evaluated by measuring vessel diameter variation in the stented segment, before and after selective intracoronary infusion of acetylcholine (iiAch). RESULTS: In eligible patients, the relative magnitudes of major vasoconstriction were 2.6, 2.9, 4.6, and 3.1 at 5 mm proximal and 5, 10 and 20 distal to the stent edge. Overall, a 3.5 fold major distal vasoconstriction after iiAch of SES vs. BMS was calculated. CONCLUSIONS: in the same patients, but treating different coronary segments, SES implantation induces a higher rate of vasoconstriction compared to BMS. The increased vasoconstriction after iiAch is an indicator of ED. © 2013 Wiley Periodicals, Inc.
Authors:
Alexandru Nicolae Mischie; Marco Stefano Nazzaro; Rosario Fiorilli; Francesco De Felice; Carmine Musto; Pierpaolo Confessore; Antonio Parma; Carla Boschetti; Roberto Violini
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-29
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Wiley Periodicals, Inc.
Affiliation:
U.O. Cardiologia Interventistica, Ospedale San Camillo, C.ne Gianicolense n. 87, 00152 Roma, Italy; Cardiology Department, "Bagdasar-Arseni" Emergency Hospital, 12 Berceni Street, 4th sector, 041915 Bucharest, Romania. alexandru_mischie@yahoo.com.
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