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Comparison of the vessel healing process after everolimus-eluting stent and bare metal stent implantations in patients with ST-elevation myocardial infarction

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Abstract

Cobalt–chromium everolimus-eluting stent (CoCr EES) is associated with a lower rate of stent thrombosis even in patients with ST-elevation myocardial infarction (STEMI). However, the time-serial changes of endothelial coverage of the stent struts in the extremely early period have never been reported, especially in patients with STEMI. The aim of this study was to compare the vessel healing process between CoCr EES and cobalt–chromium bare metal stent (CoCr BMS) implantations using optical coherence tomography (OCT) in patients with STEMI. Sixty-three patients who had primary emergent percutaneous coronary intervention (PCI) with CoCr EES (42 patients) or CoCr BMS (21 patients) were enrolled in this study for 3 years. OCT was performed just after, 2 and 12 weeks after EES or BMS implantations. Time-serial changes in the neointimal coverage (NIC), the neointimal thickness, and malapposition of stent struts were evaluated. NIC of stent struts did not differ between CoCr EES (23.2%, 99.4%) and CoCr BMS (24.0%, 97.8%) at 2 weeks and 12 weeks after PCI, respectively. Thicknesses of the neointima on the stent strut was significantly thinner in CoCr EES (34.0 ± 13.8, 107.0 ± 32.4 µm) than in CoCr BMS (40.0 ± 14.6, 115.7 ± 33.8 µm) at 2 weeks and 12 weeks after PCI (p = 0.011, p = 0.008), respectively. The malapposition did not differ just after PCI, and was completely resolved at 12 weeks after PCI in both groups. Thrombus was significantly less in CoCr EES than in CoCr BMS at 2 weeks (19.0% vs 42.9%, p < 0.01), and decreased over time in both groups, but at 12 weeks, disappeared only in CoCr EES (CoCr EES: 0% vs. CoCr BMS: 4.8%, p = 0.56). This study demonstrated that NIC and apposition of the stent struts almost completed at 12 weeks after EES and BMS implantations, while the neointimal thickness on the stent struts were thinner in EES than in BMS. Moreover, thrombus was significantly less in EES than in BMS implantations 2 weeks after PCI, which may explain the lower rate of acute and subacute stent thrombosis of EES compared with BMS.

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References

  1. Horst B, Rihal CS, Holmes DR Jr, Bresnahan JF, Prasad A, Gau G, Lennon R, Lerman A (2009) Comparison of drug-eluting and bare-metal stents for stable coronary artery disease. JACC Cardiovasc Interv 2:321–328

    Article  PubMed  Google Scholar 

  2. Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schömig A, Pfisterer ME, Stone GW, Leon MB, de Lezo JS, Goy JJ, Park SJ, Sabaté M, Suttorp MJ, Kelbaek H, Spaulding C, Menichelli M, Vermeersch P, Dirksen MT, Cervinka P, Petronio AS, Nordmann AJ, Diem P, Meier B, Zwahlen M, Reichenbach S, Trelle S, Windecker S, Jüni P (2007) Outcomes associated with drug-eluting and bare-metal stents: a collaborative network metaanalysis. Lancet 370:937–948

    Article  CAS  PubMed  Google Scholar 

  3. Babapulle MN, Joseph L, Belisle P, Brophy JM, Eisenberg MJ (2004) A hierarchical Bayesian meta-analysis of randomized clinical trials of drug-eluting stents. Lancet 364:583–591

    Article  CAS  PubMed  Google Scholar 

  4. Jeremias A, Sylvia B, Bridges J, Kirtane AJ, Bigelow B, Pinto DS, Ho KK, Cohen DJ, Garcia LA, Cutlip DE, Carrozza JP Jr (2004) Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation 109:1930–1932

    Article  PubMed  Google Scholar 

  5. Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, Kutys R, Skorija K, Gold HK, Virmani R (2006) Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 48:193–202

    Article  Google Scholar 

  6. Virmani R, Guagliumi G, Farb A, Musumeci G, Grieco N, Motta T, Mihalcsik L, Tespili M, Valsecchi O, Kolodgie FD (2004) Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation 109:701–705

    Article  PubMed  Google Scholar 

  7. Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R (2007) Pathological correlates of late drugeluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115:2435–2441

    Article  PubMed  Google Scholar 

  8. Sheiban I, Villata G, Bollati M, Sillano D, Lotrionte M, Biondi-Zoccai G (2008) Next-generation drug-eluting stents in coronary artery disease: focus on everolimus-eluting stent (Xience V). Vasc Health Risk Manag 4:31–38

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Serruys PW, Ruygrok P, Neuzner J, Piek JJ, Seth A, Schofer JJ, Richardt G, Wiemer M, Carrié D, Thuesen L, Boone E, Miquel-Herbert K, Daemen J (2006) A randomized comparison of an everolimus-eluting coronary stent with a paclitaxel-eluting coronary stent: the SPIRIT II trial. EuroIntervention 2:286–294

    Google Scholar 

  10. Planer D, Smits PC, Kereiakes DJ, Kedhi E, Fahy M, Xu K, Serruys PW, Stone GW (2011) Comparison of everolimus- and paclitaxel-eluting stents in patients with acute and stable coronary syndromes: pooled results from the SPIRIT (A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) and COMPARE (A Trial of Everolimus-Eluting Stents and Paclitaxel-Eluting Stents for Coronary Revascularization in Daily Practice) trials. JACC Cardiovasc Interv 4:1104–1115

    Article  PubMed  Google Scholar 

  11. Farb A, Burke AP, Kolodgie FD, Virmani R (2003) Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation 108:1701–1706

    Article  PubMed  Google Scholar 

  12. Palmerini T, Sangiorgi D, Valgimigli M, Biondi-Zoccai G, Feres F, Abizaid A, Costa RA, Hong MK, Kim BK, Jang Y, Kim HS, Park KW, Mariani A, Della Riva D, Genereux P, Leon MB, Bhatt DL, Bendetto U, Rapezzi C, Stone GW (2015) Short-versus long-term dual antiplatelet therapy after drug-eluting stent implantation: an individual patient data pairwise and network meta-analysis. J Am Coll Cardiol 65:1092–1102

    Article  CAS  PubMed  Google Scholar 

  13. Giustino G, Baber U, Sartori S, Mehran R, Mastoris I, Kini AS, Sharma SK, Pocock SJ, Dangas GD (2015) Duration of dual antiplatelet therapy after drug-eluting stent implantation: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Cardiol 65:1298–1310

    Article  CAS  PubMed  Google Scholar 

  14. Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, Choi D, Kang TS, Park BE, Kang WC, Lee SH, Yoon JH, Hong BK, Kwon HM, Jang Y, Investigators RESET (2012) A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol 2012(60):1340–1348

    Article  CAS  Google Scholar 

  15. Yano H, Horinaka S, Ishikawa M, Ishimitsu T (2017) Early vascular responses after everolimus-eluting stent implantation assessed by serial observations of intracoronary optical coherence tomography. Heart Vessels 32:804–812

    Article  PubMed  Google Scholar 

  16. van Werkum JW, Heestermans AA, Zomer AC, Kelder JC, Suttorp MJ, Rensing BJ, Koolen JJ, Brueren BR, Dambrink JH, Hautvast RW, Verheugt FW, ten Berg JM (2009) Predictors of coronary stent thrombosis: the Dutch Stent thrombosis registry. J Am Coll Cardiol 53:1399–1409

    Article  PubMed  Google Scholar 

  17. Dangas GD, Caixeta A, Mehran R, Parise H, Lansky AJ, Cristea E, Brodie BR, Witzenbichler B, Guagliumi G, Peruga JZ, Dudek D, Möeckel M, Stone GW, Harmonizing Outcomes with Revascularization Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial Investigators (2011) Frequency and predictors of stent thrombosis after percutaneous coronary intervention in acute myocardial infarction. Circulation 123:1745–1756

    Article  PubMed  Google Scholar 

  18. Feres F, Costa RA, Abizaid A, Leon MB, Marin-Neto JA, Botelho RV, King SB 3rd, Negoita M, Liu M, de Paula JE, Mangione JA, Meireles GX, Castello HJ Jr, Nicolela EL Jr, Perin MA, Devito FS, Labrunie A, Salvadori D Jr, Gusmão M, Staico R, Costa JR Jr, de Castro JP, Abizaid AS, Bhatt DL, Trial Investigators OPTIMIZE (2013) Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA 310:2510–2522

    CAS  PubMed  Google Scholar 

  19. de Jaegere P, Mudra H, Figulla H, Almagor Y, Doucet S, Penn I, Colombo A, Hamm C, Bartorelli A, Rothman M, Nobuyoshi M, Yamaguchi T, Voudris V, DiMario C, Makovski S, Hausmann D, Rowe S, Rabinovich S, Sunamura M, van Es GA (1998) Intravascular ultrasound-guided optimized stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study (MUSIC Study). Eur Heart J 19:1214–1223

    Article  PubMed  Google Scholar 

  20. Imola F, Mallus MT, Ramazzotti V, Manzoli A, Pappalardo A, Di Giorgio A, Albertucci M, Prati F (2010) Safety and feasibility of frequency domain optical coherence tomography to guide decision making in percutaneous coronary intervention. EuroIntervention 6:575–581

    Article  PubMed  Google Scholar 

  21. Gonzalo N, Serruys PW, Okamura T, Shen ZJ, Onuma Y, Garcia-Garcia HM, Sarno G, Schultz C, van Geuns RJ, Ligthart J, Regar E (2009) Optical coherence tomography assessment of the acute effects of stent implantation on the vessel wall: a systematic quantitative approach. Heart 95:1913–1919

    Article  CAS  PubMed  Google Scholar 

  22. Gutiérrez-Chico JL, Alegría-Barrero E, Teijeiro-Mestre R, Chan PH, Tsujioka H, de Silva R, Viceconte N, Lindsay A, Patterson T, Foin N, Akasaka T, di Mario C (2012) Optical coherence tomography: from research to practice. Eur Heart J Cardiovasc Imaging 13:370–384

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tanaka N, Terashima M, Rathore S, Itoh T, Habara M, Nasu K, Kimura M, Itoh T, Kinoshita Y, Ehara M, Tsuchikane E, Asakura K, Asakura Y, Katoh O, Suzuki T (2010) Different patterns of vascular response between patients with or without diabetes mellitus after drug-eluting stent implantation: optical coherence tomographic analysis. JACC Cardiovasc Interv 3:1074–1079

    Article  PubMed  Google Scholar 

  24. Joner M, Nakazawa G, Finn AV, Quee SC, Coleman L, Acampado E, Wilson PS, Skorija K, Cheng Q, Xu X, Gold HK, Kolodgie FD, Virmani R (2008) Endothelial cell recovery between comparator polymer-based drug-eluting stents. J Am Coll Cardiol 52:333–342

    Article  CAS  PubMed  Google Scholar 

  25. Takano M, Yamamoto M, Mizuno M, Murakami D, Inami T, Kimata N, Murai K, Kobayashi N, Okamatsu K, Ohba T, Seino Y, Mizuno K (2010) Late vascular responses from 2 to 4 years after implantation of sirolimus-eluting stents: serial observations by intracoronary optical coherence tomography. Circ Cardiovasc Interv 3:476–483

    Article  CAS  PubMed  Google Scholar 

  26. Katoh H, Shite J, Shinke T, Matsumoto D, Tanino Y, Ogasawara D, Sawada T, Miyoshi N, Kawamori H, Yoshino N, Hirata K (2009) Delayed neointimalization on sirolimus-eluting stents: 6-month and 12-month follow up by optical coherence tomography. Circ J 73:1033–1037

    Article  PubMed  Google Scholar 

  27. Yano H, Horinaka S, Ishikawa M, Ishimitsu T (2017) Early vascular responses after everolimus-eluting stent implantation assessed by serial observations of intracoronary optical coherence tomography. Heart Vessels 32:804–812

    Article  PubMed  Google Scholar 

  28. Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97:1713–1717

    Article  PubMed  Google Scholar 

  29. Tanigawa J, Barlis P, Di Mario C (2007) Intravascular optical coherence tomography: optimisation of image acquisition and quantitative assessment of stent strut apposition. EuroIntervention 3:128–136

    PubMed  Google Scholar 

  30. Kim J, Barlis P, Dimopoulos K, Dalby M, Moore P, Di Mario C (2009) The influence of strut thickness and cell design on immediate apposition of drug-eluting stents assessed by optical coherence tomography. Int J Cardiol 134:180–188

    Article  Google Scholar 

  31. Kim TH, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK (2011) Long-term (%3e2 years) follow-up optical coherence tomographic study after sirolimus- and paclitaxel-eluting stent implantation: comparison to 9-month follow-up results. Int J Cardiovasc Imaging 27:875–881

    Article  PubMed  Google Scholar 

  32. Awata M, Kotani J, Uematsu M, Morozumi T, Watanabe T, Onishi T, Iida O, Sera F, Nanto S, Hori M, Nagata S (2007) Serial angioscopic evidence of incomplete neointimal coverage after sirolimus-eluting stent implantation: comparison with bare-metal stents. Circulation 116:910–916

    Article  CAS  PubMed  Google Scholar 

  33. Takano M, Yamamoto M, Xie Y, Murakami D, Inami S, Okamatsu K, Seimiya K, Ohba T, Seino Y, Mizuno K (2007) Serial long-term evaluation of neointimal stent coverage and thrombus after sirolimus-eluting stent implantation by use of coronary angioscopy. Heart 93:1533–1536

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kubo T, Imanishi T, Kitabata H, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Takarada S, Tanaka A, Nakamura N, Mizukoshi M, Tomobuchi Y, Akasaka T (2008) Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris: a serial optical coherence tomography study. JACC Cardiovasc Imaging 1:475–484

    Article  PubMed  Google Scholar 

  35. Byrne RA, Iijima R, Mehilli J, Pinieck S, Bruskina O, Schömig A, Kastrati A (2009) Durability of antirestenotic efficacy in drug-eluting stents with and without permanent polymer. JACC Cardiovasc Interv 2(4):291–299

    Article  PubMed  Google Scholar 

  36. Nakagawa Y, Kimura T, Morimoto T, Nomura M, Saku K, Haruta S, Muramatsu T, Nobuyoshi M, Kadota K, Fujita H, Tatami R, Shiode N, Nishikawa H, Shibata Y, Miyazaki S, Murata Y, Honda T, Kawasaki T, Doi O, Hiasa Y, Hayashi Y, Matsuzaki M, Mitsudo K, j-Cypher Registry Investigators (2010) Incidence and risk factors of late target lesion revascularization after sirolimuseluting stent implantation (3-year follow-up of the j-Cypher Registry). Am J Cardiol 106:329–336

    Article  PubMed  Google Scholar 

  37. Onuma Y, Miquel-Hebert K, Serruys PW, SPIRITII Investigators (2013) Five-year long-term clinical follow-up of the XIENCE V everolimus-eluting coronary stent system in the treatment of patients with de novo coronary artery disease: the SPIRIT II trial. EuroIntervention 8:1047–1051

    Article  PubMed  Google Scholar 

  38. Yano H, Horinaka S, Ishikawa M, Ishimitsu T (2016) The efficacy of everolimus-eluting stent implantation in patients with ST-segment elevation myocardial infarction: outcomes of 2-year clinical follow-up. Heart Vessels 31:1609–1615

    Article  PubMed  Google Scholar 

  39. Holmes DR Jr, Kereiakes DJ, Garg S, Serruys PW, Dehmer GJ, Ellis SG, Williams DO, Kimura T, Moliterno DJ (2010) Stent thrombosis. J Am Coll Cardiol 56:1357–1365

    Article  PubMed  Google Scholar 

  40. Ong DS, Jang IK (2015) Causes, assessment, and treatment of stent thrombosis-intravascular imaging insights. Nat Rev Cardiol 12:325–336

    Article  PubMed  Google Scholar 

  41. Lagerqvist B, Carlsson J, Fröbert O, Lindbäck J, Scherstén F, Stenestrand U, James SK, Swedish Coronary Angiography and Angioplasty Registry Study Group (2009) Stent thrombosis in Sweden: a report from the Swedish coronary angiography and angioplasty registry. Circ Cardiovasc Interv 2:401–408

    Article  PubMed  Google Scholar 

  42. Steg PG, Fox KA, Eagle KA, Furman M, Van de Werf F, Montalescot G, Goodman SG, Avezum A, Huang W, Gore JM, Global Registry of Acute Coronary Events (GRACE) Investigators (2009) Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events. Eur Heart J 30:321–329

    Article  PubMed  Google Scholar 

  43. Kim BK, Kim JS, Park J, Ko YG, Choi D, Jang Y, Hong MK (2012) Comparison of optical coherence tomographic assessment between first- and second-generation drug-eluting stents. Yonsei Med J 53:524–529

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kolandaivelu K, Swaminathan R, Gibson WJ, Kolachalama VB, Nguyen-Ehrenreich KL, Giddings VL, Coleman L, Wong GK, Edelman ER (2011) Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings. Circulation 123:1400–1409

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Kastrati A, Mehilli J, Dirschinger J, Dotzer F, Schühlen H, Neumann FJ, Fleckenstein M, Pfafferott C, Seyfarth M, Schömig A (2001) Intracoronary stenting and angiographic results: strut thickness effect on restenosis outcome (ISAR-STEREO) trial. Circulation 103:2816–2821

    Article  CAS  PubMed  Google Scholar 

  46. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara PT, Sabatine MS, Smith PK, Smith SC Jr, Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis JS, Joglar JA, Pressler SJ, Wijeysundera DN (2016) 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 152:1243–1275

    Article  PubMed  Google Scholar 

  47. Otsuki S, Brugaletta S, Sabaté M, Shiratori Y, Gomez-Monterrosas O, Scalone G, Romero-Villafañe S, Hernández-Enríquez M, Freixa X, Martín-Yuste V, Masotti M (2016) Overtime evaluation of the vascular HEALing process after everolimus-eluting stent implantation by optical coherence tomography. The HEAL-EES study. Cardiovasc Revasc Med 17:241–247

    Article  PubMed  Google Scholar 

  48. Kimura T, Morimoto T, Natsuaki M, Shiomi H, Igarashi K, Kadota K, Tanabe K, Morino Y, Akasaka T, Takatsu Y, Nishikawa H, Yamamoto Y, Nakagawa Y, Hayashi Y, Iwabuchi M, Umeda H, Kawai K, Okada H, Kimura K, Simonton CA, Kozuma K, RESET Investigators (2012) Comparison of everolimus-eluting and sirolimus-eluting coronary stents: 1-year outcomes from the Randomized Evaluation of Sirolimus-eluting Versus Everolimuseluting stent Trial (RESET). Circulation 126:1225–1236

    Article  CAS  PubMed  Google Scholar 

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  1. Department of Cardiology and Nephrology, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan

    Hideki Yano, Shigeo Horinaka, Manami Watahik, Tomoko Watanabe & Toshihiko Ishimitsu

  2. Department of Cardiology, Nasu Red Cross Hospital, Ohtawara, Tochigi, 324-8686, Japan

    Hideki Yano

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Yano, H., Horinaka, S., Watahik, M. et al. Comparison of the vessel healing process after everolimus-eluting stent and bare metal stent implantations in patients with ST-elevation myocardial infarction. Heart Vessels 34, 572–582 (2019). https://doi.org/10.1007/s00380-018-1287-1

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