Impact of the first-generation drug-eluting stent implantation on periprocedural myocardial injury in patients with stable angina pectoris.
OBJECTIVE
Percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) is one of the standard treatments for patients with stable angina pectoris (AP). In spite of a notable effect in preventing restenosis after PCI, DES cannot improve the mortality of patients compared to a bare-metal stent (BMS). On the other hand, periprocedural myocardial injury (PMI) is related to poor prognosis in patients undergoing PCI. We compared DES to BMS in the incidence of PMI in patients with stable AP.


METHODS
We enrolled 265 consecutive patients with AP undergoing successful stent implantation. A blood sample was obtained from all patients immediately before and 24h after PCI. PMI was defined as an increase in creatine kinase-myocardial band isozyme fraction (CK-MB) greater than the upper limit of reference range 24h after PCI. During the study period, sirolimus- and paclitaxel-eluting stents were used as DES. The strategy of PCI including the type of stent to implant was left to the discretion of the operator.


RESULTS
Patients were divided into two groups (DES group, n=136 and BMS group, n=129). The incidence of PMI was significantly higher in the DES group than in the BMS group (24% vs. 12%, p=0.015). Use of DES remained an independent predictor of PMI on multivariate logistic regression analysis after adjustment for confounding factors (odds ratio 2.20, 95% CI, 1.07-4.51, p=0.032).


CONCLUSIONS
Implantation of the first-generation DES including sirolimus- and paclitaxel-eluting stents was associated with a higher incidence of PMI in patients with AP compared to BMS.
Department of Cardiology, Social Insurance Chukyo Hospital, Nagoya, Japan.
Takuya
T
Okada
Daiji
D
Yoshikawa
Hideki
H
Ishii
Masaya
M
Matsumoto
Seiichi
S
Hayakawa
Kyoko
K
Matsudaira
Miho
M
Tanaka
Soichiro
S
Kumagai
Mutsuharu
M
Hayashi
Hirohiko
H
Ando
Tetsuya
T
Amano
Toyoaki
T
Murohara
D000368:Aged; D060050:Angina, Stable / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D017239:Paclitaxel / Q000009:adverse effects; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents / Q000009:adverse effects
D015415:Biomarkers; D008670:Metals; D052279:Creatine Kinase, MB Form; D017239:Paclitaxel; D020123:Sirolimus