Treatment of acute myocardial infarction with sirolimus-eluting stents results in chronic endothelial dysfunction in the infarct-related coronary artery.
BACKGROUND
Sirolimus-eluting stent (SES) implantation aggravated endothelial vasomotor dysfunction in infarct-related coronary arteries.


RESULTS
This study examined the effect of SES implantation on the duration of reperfusion-induced endothelial vasomotor dysfunction in infarct-related coronary arteries and on postinfarct left ventricular dysfunction in acute myocardial infarction (AMI). Patients with a first AMI due to occlusion of the left anterior descending coronary artery and successful reperfusion using SES (n=15) or bare metal stents (BMS; n=18) were examined. The vasomotor response of the left anterior descending coronary artery to acetylcholine and left ventriculography were examined 2 weeks and 6 months after AMI. At 6 months after AMI, the impairment of epicardial coronary artery dilation and coronary blood flow increase in response to acetylcholine was recovered from 2 weeks after AMI in BMS-treated patients, whereas the responses of SES-treated patients improved but remained impaired compared with BMS-treated patients (% increase in blood flow, 77+/-12% in SES versus 116+/-15% in BMS at 10 microg/min of acetylcholine, P<0.01). Left ventricular regional wall dysfunction in the left anterior descending coronary artery territory improved from 2 weeks to 6 months after AMI in BMS-treated patients but not in SES-treated patients (% improvement of average SD/chord, 6% in SES versus 19% in BMS, P<0.05), although left ventricular global ejection fraction was similar between the groups at any time points.


CONCLUSIONS
SES implantation may delay recovery of reperfusion-induced endothelial vasomotor dysfunction in infarct-related coronary arteries and left ventricular regional dysfunction for at least 6 months after AMI.
Obata
Jyun-Ei
JE
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Chuo City, Japan.
Nakamura
Takamitsu
T
Kitta
Yoshinobu
Y
Kodama
Yasushi
Y
Sano
Keita
K
Kawabata
Ken-Ichi
K
Saitoh
Yukio
Y
Fujioka
Daisuke
D
Kobayashi
Tsuyoshi
T
Yano
Toshiaki
T
Watanabe
Yosuke
Y
Watanabe
Kazuhiro
K
Kugiyama
Kiyotaka
K
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003331:Coronary Vessels / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D020123:Sirolimus