Abstract 12300: Time-Dependent Changes of Local Vascular Response and Angiographic Peri-Stent Contrast Staining up to Five Years After Zotarolimus-Eluting, Sirolimus-Eluting, and Bare Metal Stent Implantation
Purpose: We have previously reported local persistent hypercoagulability six months after sirolimus-eluting stent (SES) implantation by measuring plasma prothrombin fragment F1+2 (frF1+2) levels. The aims of this study are to examine the relationship between time-dependent changes of local vascular response and angiographic peri-stent contrast staining (PSS) following zotarolimus-eluting stent (ZES), SES, and bare-metal stent (BMS) implantation.
Methods: Eighty-five patients treated five years earlier with coronary stenting, with no evidence of restenosis, were studied [ZES: 20, SES: 35, and BMS: 30]. We measured the levels of frF1+2 and pentraxin3 (PTX3) from the coronary sinus (CS) and sinus of Valsalva (V) 6 months (6M) and 5 years (5Y) after stent implantation. The transcardiac gradient (Δ) was defined as the CS levels minus V levels. The occurrence rate of PSS was evaluated and compared among ZES, SES, and BMS groups.
Results: The ΔfrF1+2 (6M) was smaller in the ZES or BMS group than in the SES group (5.5±8.4, 4.7±13.4 vs. 23.4±21.1 pmol/l, p=0.03, p=0.02, respectively). A larger percent diameter stenosis(6M) was observed in the ZES or BMS groups than in the SES group (17.1±13.2, 25.1±15.6 vs 7.1±16.5 %, p=0.04, p=0.03, respectively). The time-dependent reduction of ΔfrF1+2 [ΔfrF1+2 (5Y) minus ΔfrF1+2 (6M)] was significantly greater in the SES group than in the BMS group (-13.1±10.8 vs -0.9±9.0 pmol/l, p=0.009). The PSS (6M) was not observed in the three groups, however, the PSS (5Y) was observed in 4 patients (11.4%) only in the SES group. The ΔfrF1+2 (5Y) of the patients with PSS (n=4) was significantly greater than those without PSS (n=31) (23.5±13.4 vs 3.5±11.2 pmol/l, p≤0.05) and the ΔPTX3 (5Y) of the patients with PSS was greater than those without PSS (0.07±0.04 vs -0.01±0.09 ng/ml, p=0.09).
Conclusions: More time-dependent decrease of local coagulation response was observed after SES implantation as compared to ZES or BMS implantation. However, careful long-term observation might be recommended due to local elevated vascular response in patients with late acquired PSS following SES implantation.
- © 2013 by American Heart Association, Inc.