Abstract 11186: Downstream Coronary Effects of Drug Eluting Stents: A Propensity Matched Analysis
Introduction: Drug eluting stents (DES) target local endothelial trauma and prevent in-stent restenosis. The antiproliferative agents used in DES have been shown to attenuate atherosclerosis, however the downstream (paracrine) effects of DES have not been previously directly examined.
Hypothesis: Delivery of drug from DES prevents the development of de-novo atherosclerosis in the downstream vessel when compared to use of bare-metal stents (BMS).
Methods: A large, single-center, interventional database was utilized to identify patients undergoing initial PCI. These patients underwent implantation of a single stent in a proximal coronary artery with no initial downstream disease and then returned for a subsequent intervention within 12 months. Among these 463 patients, a non-intervened upon control vessel was also identified. Propensity matching was then performed on this cohort, identifying 89 pairs of patients. The primary endpoint was defined as the identification of a de-novo stenosis in the downstream vessel during repeat angiography.
Results: Among the matched patients, 24 new lesions were identified in the downstream aspect of target vessels compared to 9 new lesions in control vessels (p<0.01). There was lesser likelihood of lesions developing downstream to DES compared with BMS (13% vs. 38%, p=0.01). No difference in downstream lesions was seen in the respective control vessels of each stent type (8% vs. 8%, p=0.99).
Conclusions: Patients receiving DES are less likely to develop downstream lesions compared to BMS, suggesting beneficial downstream drug delivery. Control vessels were not affected, implying limited systemic delivery. The use of a stent for paracrine drug delivery in coronary arteries deserves further study.
- Drug eluting stents
- Coronary vessels
- Coronary artery disease
- Percutaneous coronary intervention
- Interventional cardiology
- © 2010 by American Heart Association, Inc.