Head-to-head comparison of sirolimus-eluting stent versus bare metal stent evaluation of the coronary endothelial dysfunction in the same patient presenting with multiple coronary artery lesions: the CREDENTIAL study.
OBJECTIVE
To assess the endothelial dysfunction (ED) after bare metal stents (BMS) and sirolimus eluting stents (SES) implantation in the same patient, overcoming the confounding role of individual variables.


BACKGROUND
SES reduce restenosis rate compared to BMS but causes more ED. ED is a potentially unsafe phenomenon, since it is the first step in the cascade of atherosclerosis. Studies showing more pronounced ED with drug eluting stents than BMS involved different series of patients, making the comparison difficult because endothelial function (EF) is responsive to many risk factors.


METHODS
we designed a prospective comparison of 6 months post-deployment EF of SES versus BMS implanted in the same patient, but in different coronary segments. Forty-eight lesions were randomly assigned on a 1:1 allocation using block sizing of 4 according to a computer-generated sequence (SAS System, Version 9.1) basis to treatment with SES or BMS. The EF was evaluated by measuring vessel diameter variation in the stented segment, before and after selective intracoronary infusion of acetylcholine (iiAch).


RESULTS
In eligible patients, the relative magnitudes of major vasoconstriction were 2.6, 2.9, 4.6, and 3.1 at 5 mm proximal and 5, 10 and 20 mm distal to the stent edge. Overall, a 3.5-fold major distal vasoconstriction after iiAch of SES vs. BMS was calculated.


CONCLUSIONS
in the same patients, but treating different coronary segments, SES implantation induces a higher rate of vasoconstriction compared to BMS. The increased vasoconstriction after iiAch is an indicator of ED.
U.O. Cardiologia Interventistica, Ospedale San Camillo, C.ne Gianicolense n. 87, 00152, Roma, Italy; Department of Cardiology, "Bagdasar-Arseni" Emergency Hospital, 12 Berceni Street, 4th Sector, 041915, Bucharest, Romania.
Alexandru Nicolae
AN
Mischie
Marco Stefano
MS
Nazzaro
Rosario
R
Fiorilli
Francesco
F
De Felice
Carmine
C
Musto
Pierpaolo
P
Confessore
Antonio
A
Parma
Carla
C
Boschetti
Roberto
R
Violini
D000109:Acetylcholine / Q000008:administration & dosage; D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008670:Metals; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011446:Prospective Studies; D011474:Prosthesis Design; D012384:Rome; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D002317:Cardiovascular Agents; D008670:Metals; D014662:Vasoconstrictor Agents; D000109:Acetylcholine; D020123:Sirolimus
acetylcholine; endothelial function; endothelium