Key result
Sirolimus-eluting stents linked to ~85% less neointimal obstruction vs ZES, despite higher malapposition.
Why the study?
The differences in vascular response and incidence of late acquired stent malapposition among different drug-eluting stents in acute MI patients are not well known.
Cohort (n=100)
Answers are grounded in this paper and cite their sources.
SES-associated lower neointimal obstruction but higher malapposition versus ZES in acute MI; leaves open clinical relevance and warrants prospective outcome trials.
Background: The differences in the vascular response to stent implantation or in the incidence of late acquired stent malapposition among different types of drug‐eluting stents are not well known in patients with acute myocardial infarction (MI). Hypothesis: The pattern of vascular remodeling and degree of neointimal proliferation were different depending on the different types of drug‐eluting stents. Methods: This study used intravascular ultrasound (IVUS) to investigate vascular remodeling in patients treated with implantation of sirolimus‐eluting stents (SESs) vs zotarolimus‐eluting stents (ZESs) following acute MI. The study population consisted of 100 patients with acute MI who were treated either with SES (n = 41) or ZES (n = 59) and underwent both poststenting and 9‐month follow‐up IVUS examination. Serial vascular changes surrounding stented segments were compared between SES‐ and ZES‐treated lesions. Results: Percentage of neointimal volume obstruction at follow‐up was significantly smaller in SES‐treated compared to ZES‐treated lesions (2.8 ± 7.1% vs 18.1 ± 15.7%, respectively; P < 0.001). However, positive vascular remodeling, which was defined as greater than 10% increase in external elastic membrane volume index (31.7% vs 10.2%, respectively, P = 0.007), and late acquired stent malapposition (12.0% vs 0%, respectively, P = 0.006 ) occurred more frequently in SES‐treated than in ZES‐treated lesions. Conclusions: The pattern of vascular remodeling, including positive remodeling, late acquired stent malapposition, and degree of neointimal proliferation might be different depending on the different types of drug‐eluting stents in patients with acute MI. © 2011 Wiley Periodicals, Inc. Ki‐Woon Kang, MD, and Young‐Guk Ko, MD, contributed equally to this manuscript. This study was partly supported by grants of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (No. A085012 and A102064); the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (0412‐CR02‐0704‐0001 and No. A085136); and the Cardiovascular Research Center, Seoul, Republic of Korea. The authors have no other funding, financial relationships, or conflicts of interest to disclose. Additional supporting information may be found in the online version of this article.
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Kang et al. (2011) conducted a cohort in Acute myocardial infarction (n=100). Sirolimus-eluting stents vs. Zotarolimus-eluting stents was evaluated on Percentage of neointimal volume obstruction at follow-up (p=<0.001). Sirolimus-eluting stents resulted in significantly less neointimal volume obstruction at 9 months compared to zotarolimus-eluting stents (2.8% vs 18.1%, P<0.001) but more late stent malapposition.
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