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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

A Prospective, Randomized, 6-Month Comparison of the Coronary Vasomotor Response Associated With a Zotarolimus- Versus a Sirolimus-Eluting Stent

Differential Recovery of Coronary Endothelial Dysfunction

Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea

Manuscript received August 14, 2008; revised manuscript received January 12, 2009, accepted January 12, 2009.

^_* Reprint requests and correspondence: Dr. Dong Joo Oh, Guro Hospital Cardiovascular Center, Korea University, 97 Gurodong-Gil Guro-gu, Seoul, Republic of Korea, 152-703 (Email: kjwmm{at}medimail.co.kr).

Objectives: We prospectively compared coronary endothelial dysfunction in patients with zotarolimus-eluting stent (ZES) versus sirolimus-eluting stent (SES) implantation at 6-month follow-up.

Background: A ZES has been associated with uniform and rapid healing of the endothelium.

Methods: Fifty patients were randomly treated with intravascular ultrasound-guided stenting with a single stent to the mid-segment of the left anterior descending artery (20 ZES, 20 SES, and 10 bare-metal stents), and endothelial function was estimated before and after intervention at 6-month follow-up by incremental acetylcholine (Ach) (10, 20, 50, and 100 µg/min) and nitrate (200 µg/min) infusions into the left coronary ostium. The vascular response was quantitatively measured in the 5-mm segments proximal and distal to the stent.

Results: In the drug-eluting stent groups, more intense vasoconstriction to incremental doses of Ach was observed at 6-month follow-up compared with the responses before stenting. Endothelial function associated with the ZES was more preserved at 6-month follow-up compared with the SES. Vasoconstriction to Ach was more prominent in the distal segments than the proximal segments in both the ZES and SES groups. Endothelium-independent vasodilation to nitrate did not differ significantly among the study groups.

Conclusions: Vasoconstriction in response to Ach in the peri-stent region was less pronounced in the ZES group than the SES group at 6-month follow-up, which suggests that endothelial function associated with ZES can be more preserved than the SES.

Key Words: acetylcholine • BMS • DES • endothelial dysfunction • SES • ZES

Abbreviations and Acronyms   Ach = acetylcholine   BMS = bare-metal stent(s)   DES = drug-eluting stent(s)   IVUS = intravascular ultrasound   SES = sirolimus-eluting stent(s)   ZES = zotarolimus-eluting stent(s)

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