Heart Center, Satakunta Central Hospital, Sairaalantie 3, 28500 Pori, Finland.
Int J Cardiovasc Imaging. 2012 Dec;28(8):1859-66. doi: 10.1007/s10554-012-0032-6. Epub 2012 Feb 24.
Drug-eluting stents (DES) have reduced the rate of restenosis but recent studies have raised concern over the risk of late stent thrombosis (LST). Incomplete stent endothelialization and delayed vascular healing have been associated with LST. The titanium-nitride-oxide coated bio-active stent (BAS) has shown promising results in patients with acute coronary syndromes, but there is little long-term optical coherence tomography (OCT) data comparing BAS with DES. The TITAX-AMI trial is a prospective, randomized, multicenter trial comparing BAS to paclitaxel-eluting stent (PES) in 425 patients with acute myocardial infarction. A total of 18 patients (9 per group) with no major cardiac events during follow-up, were enrolled in this substudy >36 months (mean 47 months) after stent implantation. Quantitative coronary angiography was performed and stent strut endothelialization and vascular healing were assessed with OCT. The binary stent strut coverage was significantly higher in the BAS group compared with the PES group (99.6 vs. 89.2%, p < 0.001) and there were less malapposed struts in the BAS group (0.2 vs. 13.8%, respectively, p < 0.001). The neointimal hyperplasia (NIH) thickness (266 ± 166 vs. 126 μm ± 126 μm, p < 0.001) and percentage of NIH area (26.2 vs. 7.6%, p < 0.001) were greater in the BAS group than in the PES group. Late incomplete endothelialization was not uncommon after PES implantation. Stents in the BAS group were completely endothelialized. This difference may contribute to the more common LST after PES implantation in the TITAX-AMI trial.
药物洗脱支架（DES）降低了再狭窄率，但最近的研究对晚期支架血栓形成（LST）的风险表示担忧。不完全的支架内皮化和延迟的血管愈合与 LST 有关。氮化钛氧化物涂层的生物活性支架（BAS）在急性冠状动脉综合征患者中显示出良好的效果，但比较 BAS 与 DES 的长期光学相干断层扫描（OCT）数据较少。TITAX-AMI 试验是一项前瞻性、随机、多中心试验，比较了 425 例急性心肌梗死患者使用 BAS 与紫杉醇洗脱支架（PES）的效果。在支架植入后 36 个月以上（平均 47 个月），共有 18 例（每组 9 例）患者在随访期间无重大心脏事件，纳入本亚研究。进行定量冠状动脉造影，并使用 OCT 评估支架小梁内皮化和血管愈合。BAS 组的二元支架小梁覆盖率明显高于 PES 组（99.6%比 89.2%，p < 0.001），BAS 组的支架小梁贴壁不良发生率较低（0.2%比 13.8%，分别，p < 0.001）。BAS 组的新生内膜增生（NIH）厚度（266 ± 166 µm 比 126 µm ± 126 µm，p < 0.001）和 NIH 面积百分比（26.2%比 7.6%，p < 0.001）均大于 PES 组。PES 植入后晚期不完全内皮化并不少见。BAS 组的支架完全内皮化。这种差异可能导致 TITAX-AMI 试验中 PES 植入后更常见的 LST。
