This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.06.031v1 50/14/1305    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Obata, J.-e. Articles by Kugiyama, K. Search for Related Content PubMed PubMed Citation Articles by Obata, J.-e. Articles by Kugiyama, K. Related Collections Related Article

CLINICAL RESEARCH

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

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2007 50: A31-A32. [Full Text] [PDF]

This article has been cited by other articles:

				R. Tsuburaya, S. Yasuda, T. Shiroto, Y. Ito, J. Y. Gao, K. Aizawa, Y. Kikuchi, K. Ito, J. Takahashi, H. Ishibashi-Ueda, et al. Long-term treatment with nifedipine suppresses coronary hyperconstricting responses and inflammatory changes induced by paclitaxel-eluting stent in pigs in vivo: possible involvement of Rho-kinase pathway Eur. Heart J., May 30, 2011; (2011) ehr145v1. [Abstract] [Full Text] [PDF]

				T. Shiroto, S. Yasuda, R. Tsuburaya, Y. Ito, J. Takahashi, K. Ito, H. Ishibashi-Ueda, and H. Shimokawa Role of Rho-Kinase in the Pathogenesis of Coronary Hyperconstricting Responses Induced by Drug-Eluting Stents in Pigs In Vivo J. Am. Coll. Cardiol., December 8, 2009; 54(24): 2321 - 2329. [Abstract] [Full Text] [PDF]

				G. Nickenig and J.-M. Sinning Response to Drug-Eluting Stents: Do We Need Drugs to Recompense Drug Elution? J. Am. Coll. Cardiol., December 8, 2009; 54(24): 2330 - 2332. [Full Text] [PDF]

				L. K. Pendyala, X. Yin, J. Li, J. P. Chen, N. Chronos, and D. Hou The First-Generation Drug-Eluting Stents and Coronary Endothelial Dysfunction J. Am. Coll. Cardiol. Intv., December 1, 2009; 2(12): 1169 - 1177. [Abstract] [Full Text] [PDF]

				J.-e. Obata, T. Nakamura, Y. Kitta, Y. Kodama, K. Sano, K.-I. Kawabata, Y. Saitoh, D. Fujioka, T. Kobayashi, T. Yano, et al. Treatment of Acute Myocardial Infarction With Sirolimus-Eluting Stents Results in Chronic Endothelial Dysfunction in the Infarct-Related Coronary Artery Circ Cardiovasc Interv, October 1, 2009; 2(5): 384 - 391. [Abstract] [Full Text] [PDF]

				J. W. Kim, H. S. Seo, J. H. Park, J. O. Na, C. U. Choi, H. E. Lim, E. J. Kim, S.-W. Rha, C. G. Park, and D. J. Oh 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 J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1653 - 1659. [Abstract] [Full Text] [PDF]

				N. Kukreja, Y. Onuma, H. Garcia-Garcia, J. Daemen, R. van Domburg, and P. W. Serruys Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Long-Term Outcome After Bare Metal and Drug-Eluting Stent Implantation Circ Cardiovasc Interv, October 1, 2008; 1(2): 103 - 110. [Abstract] [Full Text] [PDF]

				C. J. Pepine Provoked Coronary Spasm and Acute Coronary Syndromes J. Am. Coll. Cardiol., August 12, 2008; 52(7): 528 - 530. [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				A. Jabs, S. Gobel, P. Wenzel, A. L. Kleschyov, M. Hortmann, M. Oelze, A. Daiber, and T. Munzel Sirolimus-Induced Vascular Dysfunction: Increased Mitochondrial and Nicotinamide Adenosine Dinucleotide Phosphate Oxidase-Dependent Superoxide Production and Decreased Vascular Nitric Oxide Formation J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2130 - 2138. [Abstract] [Full Text] [PDF]

				G. Nakazawa, Q. Cheng, X. Xu, A. V. Finn, F. D. Kolodgie, and R. Virmani Drug-Eluting Stent Implantation May Not Affect Vasomotor Function in Early Phase J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1124 - 1125. [Full Text] [PDF]

				J.-e. Obata and K. Kugiyama Reply J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1125 - 1125. [Full Text] [PDF]

				J. W. Kim, S. Y. Suh, C. U. Choi, J. O. Na, E. J. Kim, S.-W. Rha, C. G. Park, H. S. Seo, and D. J. Oh Six-month comparison of coronary endothelial dysfunction associated with sirolimus-eluting stent versus Paclitaxel-eluting stent. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 65 - 71. [Abstract] [Full Text] [PDF]

				M. J. Kern Persistent endothelial dysfunction after drug-eluting stents another continuing cost of reducing restenosis. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 72 - 73. [Full Text] [PDF]