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Head‐to‐head comparison of sirolimus‐eluting stent versus bare metal stent evaluation of the coronary endothelial dysfunction in the same patient presenting with multiple coronary artery lesions: The CREDENTIAL study
Author(s) -
Mischie Alexandru Nicolae,
Nazzaro Marco Stefano,
Fiorilli Rosario,
Felice Francesco,
Musto Carmine,
Confessore Pierpaolo,
Parma Antonio,
Boschetti Carla,
Violini Roberto
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24844
Subject(s) - medicine , cardiology , vasoconstriction , restenosis , stent , endothelial dysfunction , bare metal stent , angioplasty , coronary arteries , intravascular ultrasound , coronary artery disease , artery , drug eluting stent
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 causes 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 versus 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 mm 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.