In-stent coronary restenosis, but not the type of stent, is associated with impaired endothelial-dependent vasodilatation.
BACKGROUND
Precise mechanisms leading to restenosis are not fully understood. The type of implanted stent and the intensity of atherogenic processes may affects the restenosis rate.


OBJECTIVE
To compare the long-term effects of the coronary stent implantation - paclitaxel-eluting stent (PES) or bare-metal stents (BMS) - on endothelial-dependent flow-mediated dilation (FMD), platelet-derived growth factor (PDGF) and asymmetric dimethylarginine (ADMA) serum levels and to assess the relationship between FMD, PDGF, ADMA and every-stage in-stent restenosis (eISR).


METHODS
The study population included 40 patients with coronary artery disease, who underwent elective percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD) with stent implantation (PES - 21 patients; BMS - 19 patients). Follow-up examination was performed 12 months after PCI.


RESULTS
There were no differences between the PES and the BMS patients regarding FMD (PES: 11.8+/-7.8%, BMS: 10.5+/-9.2%), PDGF (PES: 5540+/-2209 pg/ml, BMS: 4923+/-2924 pg/ml) and ADMA (PES: 0.474+/-0.04 micromol/l, BMS: 0.456+/-0.03 micromol/l) serum levels. The follow-up angiography was performed when clinically indicated in 25 patients: in 15 patients with PES and 10 patients with BMS implanted. The eISR was found in 12 subjects: in 7 (47%) with PES and in 5 (50%) with BMS (NS). In all patients with eISR, the FMD values were significantly lower (6.1+/-3.5%, p=0.003) compared to the patients without eISR (14.3+/-7.8%). FMD was the only independent risk factor for eISR (OR=0.631, 95% CI 0.412-0.942, p=0.0003). The cut-off point for FMD < or = 8.4% as a parameter predicting eISR was established (p=0.0001, sensitivity: 83.3%, specificity: 92.3%, PPV: 90.9%, NPV: 85.7%).


CONCLUSIONS
The type of stent implanted into LAD does not affect the FMD, PDGF and ADMA serum levels assessed one-year after a PCI procedure. The occurrence of an early in-stent restenosis is associated with impaired FMD at the time of one-year follow-up.
Mizia-Stec
Katarzyna
K
Department of Cardiology, Medical University of Silesia, Katowice, Poland. kmizia@op.pl
Gasior
Zbigniew
Z
Haberka
Maciej
M
Mizia
Magdalena
M
Chmiel
Artur
A
Janowska
Joanna
J
Holecki
Michał
M
Mielczarek
Marcin
M
Zahorska-Markiewicz
Barbara
B
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D023903:Coronary Restenosis / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011044:Poland; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D014664:Vasodilation
D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors