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This editorial refers to ‘Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation’† by S.H. Hofma et al. , on page 166 Hofma et al .1 report the presence of abnormal coronary vasoconstriction to the endothelium-dependent vasodilator acetylcholine distally to the site of sirolimus-eluting stent (SES) implantation. The investigators prospectively studied 15 patients undergoing stenting for a single de novo lesion: nine with a SES and six with a bare metal stent (BMS). Coronary endothelial function was assessed at baseline and 6 months follow-up. The presence of abnormal coronary flow reserve or anatomical differences between the groups was ruled out by the coronary flow response to adenosine using intracoronary Doppler and by intravascular ultrasound, respectively. There was significantly more distal epicardial vasoconstriction to acetylcholine in the SES when compared with the BMS group. The authors concluded that SES might have an adverse effect on local coronary endothelial function. The current study compliments a recent report from Togni et al .2 which demonstrated that exercise-induced coronary vasomotion is abnormal in segments distal to SES.Thus, recently two reports in the literature demonstrated the presence of coronary endothelial dysfunction related to SES when compared with BMS. However, both studies assessed coronary endothelial function by a different methodology: the current study testing the receptor-dependent response to the endothelial-dependent vasodilator acetylcholine and, Togni et al .2 using exercise-induced shear stress and endothelial-dependent vasodilatation.1 Taken together, these studies imply that the phenomenon of coronary endothelial dysfunction following SES is more generalized and not depending on a specific pathway.The endothelium is a monolayer of endothelial cells lining up the lumen of the vascular bed, strategically located from a mechanical and metabolic point … *Corresponding author. Tel: +41 21 3140010; fax: +41 21 3140067. E-mail address: eric.eeckhout{at}chuv.ch

european heart journal

Coronary endothelial dysfunction following sirolimus-eluting stent placement: should we worry about it?The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.