Korean J Intern Med.  2015 Jan;30(1):42-48. 10.3904/kjim.2015.30.1.42.

Impact of an endothelial progenitor cell capturing stent on coronary microvascular function: comparison with drug-eluting stents

• Choi WG
• Kim SH
• Yoon HS
• Lee EJ
• Kim DW

• KMID: 2129662
• DOI: http://doi.org/10.3904/kjim.2015.30.1.42

Abstract

BACKGROUND/AIMS
Although drug-eluting stents (DESs) effectively reduce restenosis following percutaneous coronary intervention (PCI), they also delay re-endothelialization and impair microvascular function, resulting in adverse clinical outcomes. Endothelial progenitor cell (EPC) capturing stents, by providing a functional endothelial layer on the stent, have beneficial effects on microvascular function. However, data on coronary microvascular function in patients with EPC stents versus DESs are lacking.
METHODS
Seventy-four patients who previously underwent PCI were enrolled in this study. Microvascular function was evaluated 6 months after PCI based on the index of microvascular resistance (IMR) and the coronary flow reserve (CFR). IMR was calculated as the ratio of the mean distal coronary pressure at maximal hyperemia to the inverse of the hyperemic mean transit time (hTmn). The CFR was calculated by dividing the hTmn by the baseline mean transit time.
RESULTS
Twenty-one patients (age, 67.2 +/- 9.6 years; male:female, 15:6) with an EPC stent and 53 patients (age, 61.5 +/- 14.7 years; male:female, 40:13) with second-generation DESs were included in the study. There were no significant differences in the baseline clinical and angiographic characteristics of the two groups. Angiography performed 6 months postoperatively did not show significant differences in their CFR values. However, patients with the EPC stent had a significantly lower IMR than patients with second-generation DESs (median, 25.5 [interquartile range, 12.85 to 28.18] vs. 29.0 [interquartile range, 15.42 to 39.23]; p = 0.043).
CONCLUSIONS
Microvascular dysfunction was significantly improved after 6 months in patients with EPC stents compared to those with DESs. The complete re-endothelialization achieved with the EPC stent may provide clinical benefits over DESs, especially in patients with microvascular dysfunction.

Keyword

Coronary stent; Microvascular function

MeSH Terms

Aged
Blood Flow Velocity
Coronary Angiography
Coronary Artery Disease/diagnosis/physiopathology/*therapy
*Coronary Circulation
Coronary Vessels/*physiopathology/radiography
Drug-Eluting Stents
*Endothelial Progenitor Cells/radiography
Female
Humans
Male
Microvessels/*physiopathology/radiography
Middle Aged
Percutaneous Coronary Intervention/*instrumentation
Prosthesis Design
*Re-Epithelialization
*Stents
Time Factors
Treatment Outcome
Vascular Resistance