Arroyo Diego A, Schukraft Sara, Kallinikou Zacharenia, Stauffer Jean-Christophe, Baeriswyl Gérard, Goy Jean-Jacques, Togni Mario, Cook Stéphane, Puricel Serban
Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland.
Open Heart. 2018 Jan 3;5(1):e000624. doi: 10.1136/openhrt-2017-000624. eCollection 2018.
To compare endothelium-dependent vasomotor function and vascular healing 15 months after implantation of two new-generation drug-eluting stents and biovascular scaffolds (BVS).
A total of 28 patients previously treated with a SYNERGY stent (bioabsorbable polymer everolimus-eluting stents (BP-EES)), a PROMUS stent (persistent polymer everolimus-eluting stents (PP-EES)) or an ABSORB (BVS) underwent control coronary angiography, 15 months after implantation, coupled with optical coherence tomography imaging and supine bicycle exercise. Intracoronary nitroglycerin was administered after exercise testing. Coronary vasomotor response was assessed using quantitative coronary angiography at rest, during supine bicycle exercise and after nitroglycerin. The primary end point was the percent change in mean lumen diameter compared with baseline. Secondary end points were strut coverage and apposition.There were no significant differences in vasomotor response between the three treatment groups. Patients with PP-EES showed significant vasoconstriction of the proximal peristent segment at maximum exercise (P=0.02). BP-EES (2.7%, 95% CI 0 to 5.5) and BVS (3.2%, 95% CI 0 to 6.7) showed less uncovered struts than PP-EES (12.1%, 95% CI 2.9 to 21.3, P=0.02 and 0.09, respectively). Complete strut apposition was more frequently seen with BP-EES (99.6%, 95% CI 99.2 to 100) than with BVS (98.9%, 95% CI 98.2 to 99.6, P=0.04) or PP-EES (95.0%, 95% CI 91.6 to 98.5, P=0.001).
BVS and thin strut BP-EES have a reassuring vasomotion profile, suggesting minimal endothelial dysfunction 15 months after implantation.
比较两种新一代药物洗脱支架和生物可降解血管支架（BVS）植入15个月后的内皮依赖性血管舒缩功能和血管愈合情况。
共有28例曾接受SYNERGY支架（生物可吸收聚合物依维莫司洗脱支架（BP-EES））、PROMUS支架（永久性聚合物依维莫司洗脱支架（PP-EES））或ABSORB（BVS）治疗的患者，在植入15个月后接受冠状动脉造影检查，并进行光学相干断层扫描成像和仰卧位自行车运动试验。运动试验后给予冠状动脉内硝酸甘油。使用定量冠状动脉造影评估静息、仰卧位自行车运动期间及硝酸甘油给药后的冠状动脉血管舒缩反应。主要终点是平均管腔直径相对于基线的变化百分比。次要终点是支架覆盖率和贴壁情况。三个治疗组之间的血管舒缩反应无显著差异。PP-EES组患者在最大运动时近端永久性节段出现显著血管收缩（P=0.02）。BP-EES（2.7%，95%CI 0至5.5）和BVS（3.2%，95%CI 0至6.7）的未覆盖支架比PP-EES（12.1%，95%CI 2.9至21.3，P分别为0.02和0.09）少。与BVS（98.9%，95%CI 98.2至99.6，P=0.04）或PP-EES（95.0%，95%CI 91.6至98.5，P=0.001）相比，BP-EES（99.6%，95%CI 99.2至100）更常出现完全支架贴壁。
BVS和薄支架BP-EES具有令人放心的血管运动特征，表明植入15个月后内皮功能障碍最小。
