Morino Yoshihiro, Terashita Daisuke, Otake Hiromasa, Kikuchi Tatsuo, Fusazaki Tetsuya, Kuriyama Nehiro, Suzuki Takahide, Ito Yoshiaki, Hibi Kiyoshi, Tanaka Hiroyuki, Ishihara Shozo, Kataoka Toru, Morita Takashi, Otsuka Yoritaka, Hayashi Takatoshi, Tanabe Kengo, Shinke Toshiro
Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Cardiovasc Interv Ther. 2019 Jan;34(1):14-24. doi: 10.1007/s12928-017-0507-4. Epub 2018 Jan 9.
The use of cobalt-chromium everolimus-eluting stents (CoCr-EES) for ST-segment elevation myocardial infarction (STEMI) reduces the incidence of stent thrombosis compared with bare metal stents, and a substantial difference is apparent in the initial 2 weeks. However, vascular behavior during this early period remains unclear. This was a prospective study (MECHANISM-AMI-2W) to investigate early vascular responses in STEMI patients immediately after CoCr-EES implantation and at 2-week follow-up using frequency domain-optical coherence tomography (FD-OCT). The study enrolled 52 patients (age 63.7 ± 11.7 years, male 85.0%), of whom 44 patients were available for complete serial FD-OCT analyses. Both % uncovered struts and % malapposed struts were improved at 2-week follow-up (63 ± 20 vs. 21 ± 14%, p < 0.0001 and 7.3 ± 9.0 vs. 4.7 ± 5.9%, p = 0.005, respectively). Thrombus was decreased, with significant changes in longitudinal length to stent (28.8 ± 27.7 vs. 18.1 ± 20.2%, p = 0.0001) and maximal area (0.93 ± 0.84 vs. 0.65 ± 0.63 mm, p = 0.034). As a result, the average lumen area was significantly larger at 2 weeks (6.49 ± 1.82 vs. 6.71 ± 1.89 mm, p = 0.048, respectively). The number of dissection flaps was lower (0.86 ± 1.11 vs. 0.52 ± 0.90%, p = 0.024). In conclusion, this study showed early vascular responses to CoCr-EES for STEMI lesions-including a significant reduction of thrombus-that resulted in lumen enlargement, earlier progression of strut coverage, and improvements in strut apposition and dissection. The combination of these factors may therefore be responsible for the safety of CoCr-EES within the initial 2 weeks.
与裸金属支架相比，使用钴铬依维莫司洗脱支架（CoCr-EES）治疗ST段抬高型心肌梗死（STEMI）可降低支架血栓形成的发生率，且在最初2周内差异明显。然而，这一早期阶段的血管变化情况仍不清楚。这是一项前瞻性研究（MECHANISM-AMI-2W），旨在使用频域光学相干断层扫描（FD-OCT）研究STEMI患者在植入CoCr-EES后即刻及2周随访时的早期血管反应。该研究纳入了52例患者（年龄63.7±11.7岁，男性占85.0%），其中44例患者可进行完整的系列FD-OCT分析。在2周随访时，未覆盖支架百分比和贴壁不良支架百分比均有所改善（分别为63±20%对21±14%，p<0.0001；7.3±9.0%对4.7±5.9%，p=0.005）。血栓减少，支架纵向长度（28.8±27.7%对18.1±20.2%，p=0.0001）和最大面积（0.93±0.84对0.65±0.63mm，p=0.034）有显著变化。结果，2周时平均管腔面积显著增大（分别为6.49±1.82对6.71±1.89mm，p=0.048）。夹层瓣数量减少（0.86±1.11%对0.52±0.90%，p=0.024）。总之，本研究显示了CoCr-EES对STEMI病变的早期血管反应，包括血栓显著减少，这导致管腔扩大、支架覆盖提前进展，以及支架贴壁和夹层情况改善。因此，这些因素的综合作用可能是CoCr-EES在最初2周内安全性的原因。
