Sirolimus-eluting stents suppress neointimal formation irrespective of metallic allergy.
BACKGROUND
Metallic allergy is associated with restenosis following bare metal stent implantation, but the impact of metallic allergy on the outcome after implantation of drug-eluting stents (DES) has not been investigated.


RESULTS
The present study group consisted of 88 consecutive patients (109 lesions) who underwent percutaneous coronary intervention with sirolimus-eluting stents (SES). Follow-up angiography was obtained at 8 months in all patients. At that time, the patients underwent epicutaneous patch tests for nickel, chromate, molybdenum, manganese, and titanium, which were evaluated after 48 h of contact. The patch test was positive in 14 patients (16%) (5 for manganese, 3 for nickel, 1 for chromate, 1 for Nickel and manganese, and 4 for manganese and chromate). The binary restenosis rate in the patients with a positive patch test was similar to those with negative patch test (6.3% vs 6.5%, p=0.98). Serial quantitative coronary angiography analyses identified no significant differences in late lumen loss of in-stent segments between patients with positive patch test and those with negative patch test (0.19+/-0.49 mm vs 0.12+/-0.48 mm, p=0.55).


CONCLUSIONS
SES prevent restenosis irrespective of metallic allergy. The classic relationship between metallic allergy and in-stent restenosis, seen with bare metal stents, does not appear to arise with DES, possibly because of the immunosuppressive effect of sirolimus.
Nakazawa
Gaku
G
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Tanabe
Kengo
K
Aoki
Jiro
J
Onuma
Yoshinobu
Y
Higashikuni
Yasutomi
Y
Yamamoto
Hirosada
H
Ohtsuki
Shuji
S
Yachi
Sen
S
Yagishita
Atsuhiko
A
Nakajima
Hiroyoshi
H
Hara
Kazuhiro
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002840:Chromates / Q000276:immunology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000276:immunology / Q000628:therapy*; D023903:Coronary Restenosis / Q000276:immunology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008345:Manganese / Q000276:immunology; D008670:Metals / Q000276:immunology*; D008875:Middle Aged; D008982:Molybdenum / Q000276:immunology; D009532:Nickel / Q000276:immunology; D010328:Patch Tests; D020123:Sirolimus / Q000008:administration & dosage*; D014025:Titanium / Q000276:immunology; D016896:Treatment Outcome; D017539:Tunica Intima / Q000276:immunology
D002840:Chromates; D007166:Immunosuppressive Agents; D008670:Metals; D008345:Manganese; D009532:Nickel; D008982:Molybdenum; D014025:Titanium; D020123:Sirolimus