European Heart Journal Advance Access originally published online on October 25, 2005
European Heart Journal 2006 27(2):166-170; doi:10.1093/eurheartj/ehi571
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Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation
Department of Cardiology, Thoraxcenter, Erasmus MC, Bd 412, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Received 5 October 2004; revised 11 August 2005; accepted 25 August 2005; online publish-ahead-of-print 25 October 2005.
* Corresponding author. Tel: +31 10 4635245. E-mail address: w.j.vandergiessen{at}erasmusmc.nl
See page 125 for the editorial comment on this article (doi:10.1093/eurheartj/ehi641)
Aims Endothelial dysfunction has been related both to progression of atherosclerotic disease and to future cardiovascular events. We assessed local epicardial endothelial function 6 months after sirolimus-eluting stent (SES) or bare metal stent (BS) implantation.
Methods and results In 12 patients (seven SES, five BS), endothelium-dependent vasomotion of a coronary segment 15 mm in length, starting 2 mm distal to the stent, was assessed with quantitative coronary angiography immediately after the procedure and at 6 months follow-up, after intracoronary infusion of acetylcholine. Intravascular ultrasound (IVUS) was performed and coronary flow reserve (CFR) assessed in all patients. At follow-up significant vasoconstriction was seen in SES (median 32% diameter reduction from baseline) but not in BS (median 2% reduction) patients after acetylcholine infusion (P=0.03 for SES vs. BS); endothelium-independent vasodilatation to nitrates did not differ significantly between groups (20% SES, 5% BS, P=0.14). IVUS revealed no late unhealed dissections and CFR was comparable between groups (SES 3.1 vs. BS 3.2, n.s.).
Conclusion SES implantation may have an adverse effect on local endothelium-dependent vasomotor responses compared with BS implantation at 6 months. Long-term clinical consequences of this observation are still unknown.
Key Words: Coronary stents • Drugs • Endothelium
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