Abstract 17319: Biological Determinants of Neointimal Proliferation After Intracoronary Therapy With Drug-Eluting Devices: Role of Endothelial Progenitor Cells and Interleukin 1 Family
Objectives: A prospective randomized trial (Fig. 1) compared the Xience V everolimus-eluting stent (DES) with the Coroflex Blue bare metal stent postdilated with the Sequent Please paclitaxel-eluting balloon (BMS+DEB) in patients (pt) with stable angina using optical coherence tomography (OCT) at 6-month follow-up (f/u).
Methods: Noncovered struts (in %) and the volume of neointimal proliferation indexed per cm stent length (in mm3/cm) were determined by OCT. EPC were counted as cells simultaneously expressing CD34, CD133 and KDR epitopes and apoptosis was assessed by annexin V test. EPC and interleukins were measured at baseline and f/u and given as mean values.
Results: OCT and blood samples were available in 76 pt (38 pt with 47 DES and 38 pt with 39 BMS+DEB). More neointimal proliferation was seen after BMS+DEB (15.69 ± 7.6 mm3/cm vs. 11.21 ± 5.3 mm3/cm after DES, p=0.002). The proportion of uncovered struts did not differ between DES (4.1 ± 8.9 %) and BMS+DEB (3.8 ± 7.3 %, n.s.). For DES, indexed neointimal volume correlated inversely with age (r=-0.33, p=0.019) and with the noncovered struts (r=-0.48, p=0.001) and interleukins correlated with age (IL1ra: r=0.46, p=0.011; IL18: r=0.4, p=0.021), too. For BMS+DEB, indexed neointimal volume correlated inversely with EPC (r=-0.33, p=0.02) and with the noncovered struts (r=-0.59, p<0.001), while noncoverage showed a positive association with EPC (r=0.37, p=0.012) and an inverse relationship with apoptotic EPC (r=-0.33, p=0.023). In the entire population, indexed neointimal volume was inversely associated with EPC (r=-0.27, p=0.009) and noncoverage (r=-0.48, p<0.001), the latter was also inversely correlated with apoptotic EPC (r=-0.29, p=0.006) and IL1ra was associated with age (r=0.33, p=0.007).
Conclusions: DES was associated with less neointimal proliferation at 6 months than BMS+DEB, while the strut coverage was similar. EPC might help to refine patient selection for certain drug-eluting device therapies.
- © 2013 by American Heart Association, Inc.