Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Chuo City, Japan.
Circ Cardiovasc Interv. 2009 Oct;2(5):384-91. doi: 10.1161/CIRCINTERVENTIONS.108.821371. Epub 2009 Sep 29.
Sirolimus-eluting stent (SES) implantation aggravated endothelial vasomotor dysfunction in infarct-related coronary arteries.
This study examined the effect of SES implantation on the duration of reperfusion-induced endothelial vasomotor dysfunction in infarct-related coronary arteries and on postinfarct left ventricular dysfunction in acute myocardial infarction (AMI). Patients with a first AMI due to occlusion of the left anterior descending coronary artery and successful reperfusion using SES (n=15) or bare metal stents (BMS; n=18) were examined. The vasomotor response of the left anterior descending coronary artery to acetylcholine and left ventriculography were examined 2 weeks and 6 months after AMI. At 6 months after AMI, the impairment of epicardial coronary artery dilation and coronary blood flow increase in response to acetylcholine was recovered from 2 weeks after AMI in BMS-treated patients, whereas the responses of SES-treated patients improved but remained impaired compared with BMS-treated patients (% increase in blood flow, 77+/-12% in SES versus 116+/-15% in BMS at 10 microg/min of acetylcholine, P<0.01). Left ventricular regional wall dysfunction in the left anterior descending coronary artery territory improved from 2 weeks to 6 months after AMI in BMS-treated patients but not in SES-treated patients (% improvement of average SD/chord, 6% in SES versus 19% in BMS, P<0.05), although left ventricular global ejection fraction was similar between the groups at any time points.
SES implantation may delay recovery of reperfusion-induced endothelial vasomotor dysfunction in infarct-related coronary arteries and left ventricular regional dysfunction for at least 6 months after AMI.
西罗莫司洗脱支架（SES）植入加重了梗死相关冠状动脉的内皮血管舒缩功能障碍。
本研究探讨了 SES 植入对梗死相关冠状动脉再灌注诱导的内皮血管舒缩功能障碍持续时间以及急性心肌梗死（AMI）后左心室功能障碍的影响。对 15 例接受 SES 和 18 例接受裸金属支架（BMS）治疗的左前降支闭塞和成功再灌注的首次 AMI 患者进行了研究。在 AMI 后 2 周和 6 个月检测左前降支对乙酰胆碱的血管舒缩反应和左心室造影。在 AMI 后 6 个月，BMS 治疗组患者的内皮依赖性扩张和乙酰胆碱诱导的冠状动脉血流增加的损害从 AMI 后 2 周开始恢复，而 SES 治疗组患者的反应虽然有所改善，但仍较 BMS 治疗组受损（血流增加百分比，SES 组 10μg/min 乙酰胆碱时为 77+/-12%，BMS 组为 116+/-15%，P<0.01）。在 BMS 治疗组，AMI 后 2 周至 6 个月，左前降支区域的左心室局部壁功能障碍得到改善，但 SES 治疗组无改善（平均 SD/弦的改善百分比，SES 组为 6%，BMS 组为 19%，P<0.05），尽管两组在任何时间点的左心室整体射血分数相似。
SES 植入可能会延迟梗死相关冠状动脉再灌注诱导的内皮血管舒缩功能障碍和左心室局部功能障碍的恢复，至少在 AMI 后 6 个月内如此。
