Silicon carbide-coated stents in patients with acute coronary syndrome.
Silicon carbide (aSIC-C) is a stent coating with antithrombogenic as well as anti-inflammatory properties as compared with uncoated stainless steal based on in vitro and in vivo studies. This study investigated the potential of this coating in patients with unstable angina. At 38 study sites, 485 patients were randomized to an aSIC-C (n = 238) or a conventional stainless steal stent (n = 247). Patient were classified according to angina at rest within last 48 hr to Braunwald in class IIB (= 314) and IIIB (n = 171). The primary endpoint was a combination of death, myocardial infarction, or ischemia-driven target vessel revascularization at 6 months. Complications of procedures performed at 0.4 +/- 1.1 days after admission occurred at lower rates than previously reported in this high-risk population, but the primary endpoint was not different between the study groups. Only in Braunwald class IIIB patients did the primary endpoint occur less frequently in patients with an aSIC-C stent as compared to patients with a conventional stent (5.8% vs. 15.3%; P = 0.049). At 9-month follow-up, the level of difference was maintained, but statistical significance was lost. Quantitative angiography revealed no significant difference between the stents in the subgroups. This study suggests that aSIC-C stents exert clinically measurable effects in patients with unstable angina with recent symptoms at rest. This coating deserves further clinical investigation and may serve as platform for antiproliferative drugs.
Hamm
Christian W
CW
Kerckhoff Heart Center, Bad Nauheim, Germany. christian.hamm@kerckhoff.med.uni-giessen.de
Hugenholtz
Paul G
PG
D000208:Acute Disease; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D017554:Carbon Compounds, Inorganic / Q000627:therapeutic use*; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D004562:Electrocardiography; D023381:Endpoint Determination; D004867:Equipment Design / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index; D017655:Silicon Compounds / Q000627:therapeutic use*; D015607:Stents; D013577:Syndrome; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
D015415:Biomarkers; D017554:Carbon Compounds, Inorganic; D020099:Coated Materials, Biocompatible; D017655:Silicon Compounds; D014336:Troponin; C022088:silicon carbide