title: Comparison of neointimal hyperplasia with drug-eluting stents versus bare metal stents in patients undergoing intracoronary bone-marrow mononuclear cell transplantation following acute myocardial infarction.
abstract: The aims of this study were to assess the safety of drug-eluting stent (DES) use and to compare the incidence of in-stent restenosis (ISR) and neointimal hyperplasia formation according to the type of stent implanted (DES vs bare-metal stents [BMS]) in patients who underwent intracoronary bone marrow mononuclear cell transplantation after acute ST elevation myocardial infarction. Fifty-nine patients with successfully revascularized ST elevation myocardial infarction (37 using BMS and 22 using DES) underwent paired angiographic examinations at baseline and 6 to 9 months after the intracoronary injection of 91 million +/- 56 million autologous bone marrow mononuclear cells. A subgroup of 30 patients also underwent serial intravascular ultrasound examinations. Off-line angiographic assessment showed 4 cases of binary ISR, primarily in BMS (3 cases), and no major adverse cardiac events were associated with stent type (mean follow-up period 41 +/- 10 months). At follow-up, angiographic late luminal loss was significantly lower in patients with DES than in those patients with BMS (0.35 +/- 0.66 vs 0.71 +/- 0.38 mm, p = 0.011). Multivariate analysis identified the use of DES (beta = -0.32, 95% confidence interval [CI] -0.57 to -0.26, p = 0.03) and a smaller baseline reference vessel diameter (beta = 0.29, 95% CI 0.04 to 0.54, p = 0.02) as independent predictors of lower late loss. Moreover, intravascular ultrasound showed a significant reduction of in-stent neointimal hyperplasia formation related to DES use compared with BMS use (Delta neointimal hyperplasia volume 5.4 mm(3) [95% CI 2.7 to 28.1] vs 35.9 mm(3) [95% CI 22.0 to 43.6], p = 0.035). In conclusion, these findings suggest that the use of DES is safe and may prevent ISR and neointimal hyperplasia formation in patients who undergo intracoronary bone marrow mononuclear cell transplantation after a successfully revascularized ST elevation myocardial infarction.
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Villa
authors.forename: Roman
authors.initials: R
authors.lastname: Arnold
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sánchez
authors.forename: Federico
authors.initials: F
authors.lastname: Gimeno
authors.forename: Benigno
authors.initials: B
authors.lastname: Ramos
authors.forename: Teresa
authors.initials: T
authors.lastname: Cantero
authors.forename: Maria Eugenia
authors.initials: ME
authors.lastname: Fernández
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sanz
authors.forename: Oliver
authors.initials: O
authors.lastname: Gutiérrez
authors.forename: Pedro
authors.initials: P
authors.lastname: Mota
authors.forename: Javier
authors.initials: J
authors.lastname: García-Frade
authors.forename: José Alberto
authors.initials: JA
authors.lastname: San Román
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
mesh_terms: D016026:Bone Marrow Transplantation / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D015994:Incidence; D007269:Injections, Intra-Arterial; D007963:Leukocytes, Mononuclear / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010865:Pilot Projects; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D017539:Tunica Intima / Q000473:pathology*