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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Sirolimus-Eluting Stent Implantation Aggravates Endothelial Vasomotor Dysfunction in the Infarct-Related Coronary Artery in Patients With Acute Myocardial Infarction

Department of Internal Medicine II, University of Yamanashi, Yamanashi Prefecture, Japan.

Manuscript received April 9, 2007; revised manuscript received June 7, 2007, accepted June 19, 2007.

^_* Reprint requests and correspondence: Dr. Kiyotaka Kugiyama, Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, 1110 Shimokato, Chuo City, Yamanashi Prefecture, 409-3898 Japan. (Email: kugiyama{at}yamanashi.ac.jp).

Objectives: This study examined whether sirolimus-eluting stent (SES) implantation may affect endothelial vasomotor dysfunction in resistance and epicardial infarct-related coronary arteries in acute myocardial infarction (AMI).

Background: Myocardial ischemia-reperfusion causes endothelial injury entirely in the vasculature of the infarct-related coronary artery. Sirolimus-eluting stent implantation inhibits re-endothelialization at the site of stenting.

Methods: This study included 29 patients with a first AMI due to occlusion of the left anterior descending coronary artery (LAD) and successful reperfusion therapy using a SES (n = 13) or bare-metal stent (BMS) (n = 16). The diameter of the epicardial segment distal to the site of SES deployment and coronary blood flow in the LAD in response to an intracoronary infusion of acetylcholine were measured at 2 weeks after AMI. Levels of vascular endothelial growth factor (VEGF) were measured by enzyme-linked immunoadsorbent assay in plasma obtained from the aortic root (AO) and the anterior interventricular vein (AIV) in all patients.

Results: The epicardial coronary artery was more severely constricted in response to acetylcholine in the SES than in the BMS group. The increase in coronary blood flow in response to acetylcholine was lower in the SES than in the BMS group. Vascular endothelial growth factor levels in the AIV were significantly lower than in the AO in the SES group but not in the BMS group.

Conclusions: During the course of AMI, SES implantation adversely affects endothelium-dependent vasomotor function in resistance and epicardial coronary arteries after the ischemia-reperfusion in association with a reduction in myocardial VEGF secretion.

Abbreviations and Acronyms   ACh = acetylcholine   AIV = anterior interventricular vein   AMI = acute myocardial infarction   AO = aortic root   BMS = bare-metal stent(s)   DES = drug-eluting stent(s)   LAD = left anterior descending coronary artery   LCx = left circumflex artery   SES = sirolimus-eluting stent(s)   VEGF = vascular endothelial growth factor

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