Coronary endothelial and microvascular function distal to polymer-free and endothelial cell-capturing drug-eluting stents. The randomized FUNCOMBO trial
| Autor: | Salvatore Brugaletta, Manel Sabaté, Montserrat Gracida, Beatriz Vaquerizo, Luis Ortega-Paz, Josep Gomez-Lara, Rafael Romaguera, José Luis Ferreiro, Luis Teruel, Josep Comín-Colet, Joan-Antoni Gomez-Hospital, Pedro Pérez Fuentes, Lara Fuentes, Neus Salvatella, Loreto Oyarzabal, Gerard Roura |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Polymers medicine.medical_treatment 030204 cardiovascular system & hematology Coronary Angiography Prosthesis Design 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Internal medicine Humans Medicine cardiovascular diseases Myocardial infarction Endothelial dysfunction Sirolimus Vasomotor business.industry Microcirculation Endothelial Cells Coronary flow reserve Stent Drug-Eluting Stents General Medicine equipment and supplies medicine.disease Endothelial stem cell Treatment Outcome medicine.anatomical_structure Cardiology medicine.symptom business Tomography Optical Coherence Vasoconstriction Artery |
| Zdroj: | Revista Española de Cardiología (English Edition). 74:1013-1022 |
| ISSN: | 1885-5857 |
| Popis: | Introduction and objectives The vasomotor function of new-generation drug-eluting stents designed to enhance stent healing and reendothelialization is unknown. This study aimed to compare the endothelial function of the infarct-related artery (IRA) treated with bioactive circulating endothelial progenitor cell-capturing sirolimus-eluting stents (COMBO) vs polymer-free biolimus-eluting stents (BioFreedom) in ST-segment elevation myocardial infarction patients at 6 months. Secondary objectives were to compare the microcirculatory function of the IRA and stent healing at 6 months. Methods Sixty patients were randomized to bioactive sirolimus-eluting stent vs polymer-free biolimus-eluting stents implantation. At 6 months, patients underwent coronary angiography with vasomotor, microcirculatory and optical coherence tomography examinations. Endothelial dysfunction of the distal coronary segment was defined as ≥ 4% vasoconstriction to intracoronary acetylcholine infusion. Results Endothelial dysfunction was similarly observed between groups (64.0% vs 62.5%, respectively; P = .913). Mean lumen diameter decreased by 16.0 ± 20.2% vs 16.1 ± 21.6% during acetylcholine infusion (P = .983). Microcirculatory function was similar in the 2 groups: coronary flow reserve was 3.23 ± 1.77 vs 3.23 ± 1.62 (P = .992) and the index of microcirculatory resistance was 24.8 ± 16.8 vs 21.3 ± 12.0 (P = .440). Optical coherence tomography findings were similar: uncovered struts (2.3% vs 3.2%; P = .466), malapposed struts (0.1% vs 0.3%; P = .519) and major evaginations (7.1% vs 5.6%; P = .708) were observed in few cases. Conclusions Endothelial dysfunction of the IRA was frequent and was similarly observed with new-generation drug-eluting stents designed to enhance stent reendothelialization at 6 months. Endothelial dysfunction was observed despite almost preserved microcirculatory function and complete stent coverage. Larger and clinically powered studies are needed to assess the role of residual endothelial dysfunction in ST-segment elevation myocardial infarction patients. Registered in ClinicalTrials.gov: NCT04202172 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect