title: Beneficial effects of long-acting nifedipine on coronary vasomotion abnormalities after drug-eluting stent implantation: The NOVEL study.
abstract: It is widely known that drug-eluting stents (DES) induce coronary vasomotion abnormalities. We have previously demonstrated that chronic treatment with long-acting nifedipine suppresses coronary hyperconstricting responses induced by the first-generation DES (e.g. sirolimus- and pacritaxel-eluting stents) through inhibition of vascular inflammation in pigs. To examine whether this is also the case with the second-generation DES (everolimus-eluting stents, EES) in humans, the most widely used DES in the world, we conducted a prospective, randomized, multicentre trial, termed as the NOVEL Study.
  
  
  
  We evaluated 100 patients with stable angina pectoris who underwent scheduled implantation of EES in the left coronary arteries. They were randomly assigned to receive either conventional treatments alone or additionally long-acting nifedipine (10-60 mg/day) (n = 50 each). After 8-10 months, 37 patients in the control and 38 in the nifedipine group were examined for coronary vasoreactivity to intracoronary acetylcholine (ACh) by quantitative coronary angiography after 48-h withdrawal of nifedipine. Coronary vasoconstricting responses to ACh were significantly enhanced at the distal edge of EES compared with non-stented vessel (P = 0.0001) and were significantly suppressed in the nifedipine group compared with the control group (P = 0.0044). Furthermore, the inflammatory profiles were also improved only in the nifedipine group, which evaluated by serum levels of high-sensitivity CRP (P = 0.0001) and adiponectin (P = 0.0039).
  
  
  
  These results indicate that DES-induced coronary vasomotion abnormalities still remain an important clinical issue even with the second-generation DES, for which long-acting nifedipine exerts beneficial effects associated with its anti-inflammatory effects.
  
  
  
  This study is registered at the UMIN Clinical Trial Registry (UMIN-CTR; ID=UMIN000015147).
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tsuburaya
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.affiliation: Iwate Prefectural Central Hospital, Morioka, Iwate, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nakamura
authors.affiliation: Iwate Prefectural Central Hospital, Morioka, Iwate, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Nozaki
authors.affiliation: Iwaki Kyoritsu General Hospital, Iwaki, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Sugi
authors.affiliation: Iwaki Kyoritsu General Hospital, Iwaki, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Oosaki Citizen Hospital, Osaki, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hiramoto
authors.affiliation: Hiraka General Hospital, Yokote, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Horiguchi
authors.affiliation: South Miyagai Medical Center, Ookawara, Japan.
authors.forename: Kanichi
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Yamagata Prefectural Central Hospital, Yamagata, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Goto
authors.affiliation: Sendai Open Hospital, Sendai, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.affiliation: Sendai Medical Center, Sendai, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shinozaki
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Eiko
authors.initials: E
authors.lastname: Ishida
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miyata
authors.affiliation: National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan shimo@cardio.med.tohoku.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
mesh_terms: D003327:Coronary Disease; D054855:Drug-Eluting Stents; D000068338:Everolimus; D006801:Humans; D009543:Nifedipine; D011446:Prospective Studies; D020123:Sirolimus; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus; D009543:Nifedipine; D020123:Sirolimus
keywords: Calcium channel blockers; Coronary spasm; Drug-eluting stents