Long-term coronary endothelial dysfunction associated with drug eluting stenting

초록

Backgroud: We investigated whether endothelial dysfunction was related to the drug eluting stent (DES) at 6 months after stenting. Methods: In 75 (male 31, 62.1 = 9.5 yrs) patients treated with DES to the left anterior descending artery (39 SES: Sirolimus-eluting stent, 36 PES: Paclitaxel-eluting stent) and 134 control patients without stenting (male 61, 61.2 = 11.2 yrs), endothelial function was estimated at 6 months follow up, by incremental acetylcholine infusion (A1: 20, A2: 50, A3: 100 μg/min) and nitroglycerin (200 μg/min) into the left coronary ostium. The infusion was stopped if > 90 % vasoconstriction was induced by any dose of acetylcholine. The vascular response was quantitatively measured in the arterial segment 2 mm proximal and distal to the DES and compared with the matched segments of controls. All anti-anginal agents were withheld for at least 72 hours prior to coronary angiography. Results: There was a greater vasoconstriction to Ach in both SES and PES groups than controls (p < 0.001, Figure). The vasoconstriction to Ach was more prominent in the arterial segment distal to the DES than proximal to the DES in both SES and PES groups (p < 0.001, Figure). There were no differences of vasoconstriction to Ach between SES and PES groups (Figure). Endothelium-independent vasodilatation to nitrates did not differ significantly between two groups (p = 0.211). There were no differences of risk factors between two groups. Conclusions: There was an abnormal vasoconstriction to Ach in both SES and PES, especially in the arterial segment distal to the DES at 6 months after stenting, suggesting a potential long term adverse effects of DES on local coronary endothelial dysfunction.