title: Impact of drug release kinetics on vascular response to different zotarolimus-eluting stents implanted in patients with long coronary stenoses: the LongOCT study (Optical Coherence Tomography in Long Lesions).
abstract: OBJECTIVE
  We assessed the in vivo vascular response to a new generation of zotarolimus-eluting stents (ZES) with prolonged drug release (Resolute ZES-SR, Medtronic Vascular, Santa Rosa, California) compared with ZES with faster kinetics (Endeavor ZES-FR, Medtronic Vascular) by optical coherence tomography.
  
  
  BACKGROUND
  Local drug release kinetics has been implicated with antirestenosis efficacy of drug-eluting stents. However, the impact of different release kinetics on vascular response of diseased human coronary arteries remains to be investigated.
  
  
  METHODS
  The study population consisted of 43 patients with long lesions in native coronary vessels treated with multiple overlapping ZES. Twenty-one patients treated with ZES-SR were compared with 22 patients treated with ZES-FR from the ODESSA (Optical coherence tomography for DES SAfety) study. The primary endpoint was in-stent neointimal hyperplasia as assessed by optical coherence tomography at 6-month follow-up. Coprimary endpoints were the percentage of uncovered and malapposed struts.
  
  
  RESULTS
  Strut-level median neointimal thickness was 0.11 mm (interquartile range [IQR]: 0.07 to 0.15 mm) in ZES-SR and 0.31 mm (IQR: 0.27 to 0.42 mm) in ZES-FR, respectively (p < 0.001). The 6-month rate of uncovered struts per patient was 7.38% (IQR: 3.06% to 12.72%) in ZES-SR and 0.00% (IQR: 0.00% to 0.00%) in ZES-FR (p < 0.001); rate of malapposed and uncovered struts was 1.47% (IQR: 0.32% to 4.23%) in ZES-SR and 0.00% (IQR: 0.00% to 0.00%) in ZES-FR (p < 0.001).
  
  
  CONCLUSIONS
  This study demonstrated the impact of different release kinetics on human in vivo vascular response to ZES implantation. The new generation of ZES-SR compared with ZES-FR had better suppression of the neointimal response but higher proportion of uncovered and malapposed struts at 6-month optical coherence tomography follow-up. (Optical Coherence Tomography in Long Lesions [LongOCT]; NCT01133925).
authors.affiliation: Division of Cardiology, Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy. guagliumig@gmail.com
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ikejima
authors.forename: Vasile
authors.initials: V
authors.lastname: Sirbu
authors.forename: Hiram
authors.initials: H
authors.lastname: Bezerra
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Nikoloz
authors.initials: N
authors.lastname: Lortkipanidze
authors.forename: Luigi
authors.initials: L
authors.lastname: Fiocca
authors.forename: Satoko
authors.initials: S
authors.lastname: Tahara
authors.forename: Angelina
authors.initials: A
authors.lastname: Vassileva
authors.forename: Aleksandre
authors.initials: A
authors.lastname: Matiashvili
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011474:Prosthesis Design; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: C489443:zotarolimus; D020123:Sirolimus