title: Neointimal coverage and vasodilator response to titanium-nitride-oxide-coated bioactive stents and everolimus-eluting stents in patients with acute coronary syndrome: insights from the BASE-ACS trial.
abstract: Incomplete stent endothelialization is associated with late and very late stent thrombosis. In a post hoc analysis of the BASE-ACS trial, we sought to assess neointimal coverage and coronary flow reserve (CFR) 9 months after implantation of titanium-nitride-oxide-coated bioactive stents (BAS) versus everolimus-eluting stents (EES) in patients with acute coronary syndrome (ACS). In the BASE-ACS trial, 827 patients with ACS were randomized to receive either BAS or EES. In the current study, we examined neointimal growth and strut coverage by optical coherence tomography and CFR by trans-thoracic echocardiography in 28 consecutive non-diabetic patients with the culprit lesion in the left anterior descending coronary artery. The primary endpoints were binary stent strut coverage and CFR at 9-month follow-up. A total of 13 patients were included in the BAS group (2,033 struts); 15 in the EES group (2,898 struts). Binary stent strut coverage was higher and malapposed struts lower with BAS versus EES (99.4 vs 89.2, and 0.2 vs 4.6%, respectively, p < 0.001 for both). Neointimal hyperplasia thickness was greater with BAS versus EES (274.2 vs 100.1 μm, respectively, p < 0.001). CFR was lower with EES versus BAS (2.2 ± 0.8 vs. 3.0 ± 0.5, respectively, p = 0.001). Abnormal CFR (<2.5) were detected in 10 patients in the EES group versus one in the BAS group (p = 0.002). The current study demonstrated that in patients with ACS, BAS resulted in improved neointimal stent strut coverage and better coronary vasodilator function as compared with EES at 9-month follow-up.
authors.affiliation: Satakunta Central Hospital, Pori, Finland, pasi.karjalainen@satshp.fi.
authors.forename: Pasi
authors.initials: P
authors.lastname: Karjalainen
authors.forename: Tuomas O
authors.initials: TO
authors.lastname: Kiviniemi
authors.forename: Tuomas
authors.initials: T
authors.lastname: Lehtinen
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
authors.forename: Antti
authors.initials: A
authors.lastname: Ylitalo
authors.forename: Antti
authors.initials: A
authors.lastname: Saraste
authors.forename: Jussi
authors.initials: J
authors.lastname: Mikkelsson
authors.forename: Mikko
authors.initials: M
authors.lastname: Pietila
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Juhani K E
authors.initials: JK
authors.lastname: Airaksinen
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D020099:Coated Materials, Biocompatible; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D054855:Drug-Eluting Stents; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D000068338:Everolimus; D006801:Humans; D006965:Hyperplasia; D058426:Neointima; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D016037:Single-Blind Method; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015607:Stents; D013997:Time Factors; D014025:Titanium; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014664:Vasodilation
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible; C434243:titanium-nitride-oxide; D000068338:Everolimus; D014025:Titanium; D020123:Sirolimus