In-stent restenosis in bare metal stents versus sirolimus-eluting stents after primary coronary intervention for acute myocardial infarction and subsequent transcoronary transplantation of autologous stem cells.
BACKGROUND
Following stenting for acute myocardial infarction, transcoronary transplantation of granulocyte-colony stimulating factor (G-CSF) mobilized autologous stem cells (ASC) has been shown to result in an increased in-stent restenosis rate of bare metal stents (BMS).


OBJECTIVE
This study sought to compare the extent of neointimal growth in BMS and sirolimus-eluting stents (SES) after primary implantation, and subsequent transcoronary transplantation of G-CSF mobilized stem cells.


METHODS
Patients with stenting of the left anterior descending coronary artery for acute anterior myocardial infarction were randomly assigned to receive a BMS or SES. Intracoronary stem cell injection was performed after G-CSF application for at least 4 d and cell apheresis. The angiograms obtained after cell transplantation and after 6 mo were analyzed by quantitative coronary angiography.


RESULTS
We performed primary stenting and stem cell transplantion in 16 patients who received a BMS (n = 8) or an SES (n = 8). In 2 patients with a BMS, late stent thrombosis occurred after 58 d and 177 d, respectively. In the remaining patients, control angiography after 6 mo revealed in-stent restenosis of >50% in no patients with SES but in 4 patients with BMS (67%). Late lumen loss and in-stent plaque volume were significantly higher in patients with BMS compared with patients with SES.


CONCLUSIONS
Compared with BMS, SES impair in-stent intima hyperplasia after stenting for acute myocardial infarction and transcoronary transplantation of G-CSF mobilized ASC.
Steinwender
Clemens
C
Cardiovascular Division, General and Academic Teaching Hospital of Linz, Linz, Austria. clemens.steinwender@akh.linz.at
Hofmann
Robert
R
Kypta
Alexander
A
Kammler
Juergen
J
Kerschner
Klaus
K
Grund
Michael
M
Sihorsch
Kurt
K
Gabriel
Christian
C
Leisch
Franz
F
D023903:Coronary Restenosis / Q000209:etiology*; D054855:Drug-Eluting Stents; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D020123:Sirolimus / Q000008:administration & dosage*; D033581:Stem Cell Transplantation; D015607:Stents
D016179:Granulocyte Colony-Stimulating Factor; D020123:Sirolimus