This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Byrne, R. A. Articles by Kastrati, A. Search for Related Content PubMed Articles by Byrne, R. A. Articles by Kastrati, A. Related Collections Related Article

Durability of Antirestenotic Efficacy in Drug-Eluting Stents With and Without Permanent Polymer

Robert A. Byrne, MB^_*,_*, Raisuke Iijima, MD^_*, Julinda Mehilli, MD^_*, Susanne Pinieck, RN^_*, Olga Bruskina, MD^_*, Albert Schömig, MD^_*,, Adnan Kastrati, MD^_*

^_* Deutsches Herzzentrum, Technische Universität, Munich, Germany
1. Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany

^_* Reprint requests and correspondence: Dr. Robert A. Byrne, ISAR Centre, Deutsches Herzzentrum München, Lazarettstrasse 36, 80636 Munich, Germany (Email: byrne{at}dhm.mhn.de).

Objectives: We sought to assess changes in antirestenotic efficacy of drug-eluting stents (DES) by restudying subjects at 2 time points after coronary stenting (6 to 8 months and 2 years) and to compare differences in time courses of late luminal loss (LLL) between 3 different DES platforms in use at our institution.

Background: DES therapy is associated with low levels of LLL at 6 to 8 months. The temporal course of neointimal formation after this time point remains unclear.

Methods: This prospective, observational, systematic angiographic follow-up study was conducted at 2 centers in Munich, Germany. Patients underwent stenting with permanent-polymer rapamycin-eluting stents (RES), polymer-free RES, or permanent-polymer paclitaxel-eluting stents (PES). The primary end point was delayed LLL (the difference in in-stent LLL between 6 to 8 months and 2 years).

Results: Of 2,588 patients undergoing stenting, 2,030 patients (78.4%) had 6- to 8-month angiographic follow-up and were enrolled in the study. Target lesion revascularization was performed in 259 patients; these patients were not considered for further angiographic analysis. Of 1,771 remaining patients, 1,331 had available 2-year reangiographic data (75.2%). Overall mean (SD) delayed LLL was 0.12 ± 0.49 mm (0.17 ± 0.50 mm, 0.01 ± 0.42 mm, and 0.13 ± 0.50 mm in permanent-polymer RES, polymer-free RES, and permanent-polymer PES groups, respectively [p < 0.001]). In multivariate analysis, only stent type (in favor of polymer-free RES) predicted delayed LLL.

Conclusions: Ongoing erosion of luminal caliber beyond 6 to 8 months after the index procedure is observed following DES implantation. Absence of permanent polymer from the DES platform seems to militate against this effect.

Key Words: coronary restenosis • stents/adverse effects • follow-up studies • cell proliferation/drug effects • immunosuppressive agents/therapeutic uses • polymers • 2-year reangiography

Abbreviations and Acronyms   BMS = bare-metal stent(s)   DES = drug-eluting stent(s)   LLL = late luminal loss   PES = paclitaxel-eluting stent(s)   RES = rapamycin-eluting stent(s)   TLR = target lesion revascularization

Related Article

Temporal Course of Neointimal Formation After Drug-Eluting Stent Placement: Is Our Understanding of Restenosis Changing?

Aloke V. Finn, Gaku Nakazawa, Frank D. Kolodgie, and Renu Virmani
J. Am. Coll. Cardiol. Intv. 2009 2: 300-302. [Full Text] [PDF]

This article has been cited by other articles:

				A. V. Finn, G. Nakazawa, F. D. Kolodgie, and R. Virmani Temporal Course of Neointimal Formation After Drug-Eluting Stent Placement: Is Our Understanding of Restenosis Changing? J. Am. Coll. Cardiol. Intv., April 1, 2009; 2(4): 300 - 302. [Full Text] [PDF]