Sirolimus-eluting stent implantation aggravates endothelial vasomotor dysfunction in the infarct-related coronary artery in patients with acute myocardial infarction.
OBJECTIVE
This study examined whether sirolimus-eluting stent (SES) implantation may affect endothelial vasomotor dysfunction in resistance and epicardial infarct-related coronary arteries in acute myocardial infarction (AMI).


BACKGROUND
Myocardial ischemia-reperfusion causes endothelial injury entirely in the vasculature of the infarct-related coronary artery. Sirolimus-eluting stent implantation inhibits re-endothelialization at the site of stenting.


METHODS
This study included 29 patients with a first AMI due to occlusion of the left anterior descending coronary artery (LAD) and successful reperfusion therapy using a SES (n = 13) or bare-metal stent (BMS) (n = 16). The diameter of the epicardial segment distal to the site of SES deployment and coronary blood flow in the LAD in response to an intracoronary infusion of acetylcholine were measured at 2 weeks after AMI. Levels of vascular endothelial growth factor (VEGF) were measured by enzyme-linked immunoadsorbent assay in plasma obtained from the aortic root (AO) and the anterior interventricular vein (AIV) in all patients.


RESULTS
The epicardial coronary artery was more severely constricted in response to acetylcholine in the SES than in the BMS group. The increase in coronary blood flow in response to acetylcholine was lower in the SES than in the BMS group. Vascular endothelial growth factor levels in the AIV were significantly lower than in the AO in the SES group but not in the BMS group.


CONCLUSIONS
During the course of AMI, SES implantation adversely affects endothelium-dependent vasomotor function in resistance and epicardial coronary arteries after the ischemia-reperfusion in association with a reduction in myocardial VEGF secretion.
Obata
Jyun-ei
JE
Department of Internal Medicine II, University of Yamanashi, Yamanashi Prefecture, Japan.
Kitta
Yoshinobu
Y
Takano
Hajime
H
Kodama
Yasushi
Y
Nakamura
Takamitsu
T
Mende
Akira
A
Kawabata
Ken-ichi
K
Saitoh
Yukio
Y
Fujioka
Daisuke
D
Kobayashi
Tsuyoshi
T
Yano
Toshiaki
T
Kugiyama
Kiyotaka
K
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D023921:Coronary Stenosis / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D015607:Stents; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D014666:Vasomotor System / Q000187:drug effects / Q000503:physiopathology
D007166:Immunosuppressive Agents; D042461:Vascular Endothelial Growth Factor A; D020123:Sirolimus