title: Early vascular healing after titanium-nitride-oxide-coated stent versus platinum-chromium everolimus-eluting stent implantation in patients with acute coronary syndrome.
abstract: Data on early vascular healing response of novel stent designs are scarce. In this randomized prospective trial, we sought to compare early neointimal coverage of cobalt-chromium-based titanium-nitride-oxide-coated bioactive stents (CoCr-BAS) versus platinum-chromium everolimus-eluting stents (PtCr-EES) at 2-month follow-up in patients with acute coronary syndrome (ACS). Forty patients with ACS were randomized to receive either CoCr-BAS (n = 19) or PtCr-EES (n = 21). Neointimal strut coverage and strut apposition were examined by optical coherence tomography; and coronary flow reserve (CFR), fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) were assessed using a coronary pressure wire at 2 months. Two patients in the PtCr-EES underwent OCT out of the time frame of the study, and were excluded from analysis. At 63 ± 8 days, 302 cross-sections (3412 struts) were analysed in the CoCr-BAS group, and 324 cross-sections (3460 struts) in the PtCr-EES group. Median [IQR] neointimal thickness was 203 [108] µm and 42.2 [41] µm for CoCr-BAS and PtCr-EES, respectively (p < 0.001). Median [IQR] percentage of uncovered struts was 1.2 [2.8] % versus 11.3 [17.7] %, respectively (p < 0.001). Flow measurements were comparable between the two groups (p > 0.05 for all). CoCr-BAS showed earlier and more adequate neointimal coverage of struts at 2 months, compared with PtCr-EES, but with more neointimal hyperplasia. Functional healing as assessed by CFR, FFR, and IMR was similar between the two stent arms.
authors.affiliation: Heart Centre, Turku University Hospital, University of Turku, Hämeentie 9, 20520, Turku, Finland. viveva@utu.fi.
authors.forename: Ville
authors.identifier: http://orcid.org/0000-0001-9688-5322
authors.initials: V
authors.lastname: Varho
authors.affiliation: Heart Centre, Turku University Hospital, University of Turku, Hämeentie 9, 20520, Turku, Finland.
authors.forename: Tuomas O
authors.initials: TO
authors.lastname: Kiviniemi
authors.affiliation: Heart Centre, Turku University Hospital, University of Turku, Hämeentie 9, 20520, Turku, Finland.
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
authors.affiliation: Department of Cardiology, Central Ostrobothnia Central Hospital, Kokkola, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Sia
authors.affiliation: Cardiology Unit, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Romppanen
authors.affiliation: Heart Centre, Turku University Hospital, University of Turku, Hämeentie 9, 20520, Turku, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Pietilä
authors.affiliation: Heart Centre, Turku University Hospital, University of Turku, Hämeentie 9, 20520, Turku, Finland.
authors.forename: Juhani K
authors.initials: JK
authors.lastname: Airaksinen
authors.affiliation: Heart Centre, Satakunta Central Hospital, Pori, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Mikkelsson
authors.affiliation: Heart Centre, Satakunta Central Hospital, Pori, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Tuomainen
authors.affiliation: Cardiology Unit, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anssi
authors.initials: A
authors.lastname: Perälä
authors.affiliation: Heart Centre, Satakunta Central Hospital, Pori, Finland.
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Karjalainen
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D002857:Chromium; D020099:Coated Materials, Biocompatible; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D005387:Finland; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D058426:Neointima; D009569:Nitric Oxide / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D010984:Platinum; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D014025:Titanium; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014655:Vascular Resistance; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014945:Wound Healing
chemical_list: D020099:Coated Materials, Biocompatible; D014665:Vasodilator Agents; D002857:Chromium; D009569:Nitric Oxide; D010984:Platinum; D000068338:Everolimus; D014025:Titanium
keywords: Bioactive stent; Coronary flow reserve; Drug-eluting stent; Neointimal hyperplasia; Optical coherence tomography