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Coronary endothelium-dependent vasomotor function after drug-eluting stent and bioresorbable scaffold implantation

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dc.contributor.author Gomez-Lara, Josep
dc.contributor.author Oyarzabal, Loreto
dc.contributor.author Ortega-Paz, Luis
dc.contributor.author Brugaletta, Salvatore
dc.contributor.author Romaguera, Rafael
dc.contributor.author Salvatella Giralt, Neus
dc.contributor.author Roure, Gerard
dc.contributor.author Rivero, Fernando
dc.contributor.author Fuentes, Lara
dc.contributor.author Alfonso, Fernando
dc.contributor.author Otaegui, Imanol
dc.contributor.author Vandeloo, Bert
dc.contributor.author Vaquerizo Montilla, Beatriz
dc.contributor.author Sabaté, Manel
dc.contributor.author Comín Colet, Josep
dc.contributor.author Gomez-Hospital, Joan-Antoni
dc.date.accessioned 2022-06-23T06:31:03Z
dc.date.available 2022-06-23T06:31:03Z
dc.date.issued 2021
dc.identifier.citation Gomez-Lara J, Oyarzabal L, Ortega-Paz L, Brugaletta S, Romaguera R, Salvatella N, et al. Coronary endothelium-dependent vasomotor function after drug-eluting stent and bioresorbable scaffold implantation. J Am Heart Assoc. 2021 Nov 16; 10(22): e022123. DOI: 10.1161/JAHA.121.022123
dc.identifier.issn 2047-9980
dc.identifier.uri http://hdl.handle.net/10230/53569
dc.description.abstract Background Early generation drug-eluting stents (DESs) showed a high grade of coronary endothelial dysfunction that was attributed to lack of stent reendothelialization. Endothelium-dependent vasomotor response of current DESs and bioresorbable scaffolds (BRSs) remains unknown. This study sought to assess the device-related endothelial function of current devices and to correlate neointima healing with endothelial function. Methods and Results A total of 206 patients from 4 randomized trials treated with the durable-polymer everolimus-eluting Xience (n=44), bioresorbable-polymer sirolimus-eluting Orsiro (n=35), polymer-free biolimus-eluting Biofreedom (n=24), bioactive endothelial-progenitor cell-capturing sirolimus-eluting Combo DES (n=25), polymer-based everolimus-eluting Absorb (n=44), and Mg-based sirolimus-eluting Magmaris BRS (n=34) underwent endothelium-dependent vasomotor tests and optical coherence tomography imaging, as per protocol, at follow-up. Crude vasomotor responses of distal segments to low-dose acetylcholine (10-6 mol/L) were different between groups: bioresorbablepolymer DEShad the worst (-8.4%±12.6%) and durable-polymer DES had the most physiologic (-0.4%±11.8%; P=0.014). High-dose acetylcholine (10-4 mol/L) showed similar responses between groups (ranging from -10.8%±11.6% to -18.1%±15.4%; P=0.229). Device healing was different between devices. Uncovered struts ranged from 6.3%±7.1% (bioresorbable-polymer DES) to 2.5%±4.5% (bioactive DES; P=0.056). In multivariate models, endothelium-dependent vasomotor response was associated with age, bioresorbable-polymer DES, and angiographic lumen loss, but not with strut coverage nor plaque type. Endothelial dysfunction (defined as ≥4% vasoconstriction) was observed in 46.6% of patients with low-dose and 68.9% with high-dose acetylcholine, without differences between groups. Conclusions At follow-up, endothelial dysfunction was frequently observed in distal segments treated with current stents without remarkable differences between devices. Although neointima healing was different between devices, poor healing was not associated with endothelial dysfunction.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Wiley
dc.rights Copyright © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
dc.title Coronary endothelium-dependent vasomotor function after drug-eluting stent and bioresorbable scaffold implantation
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1161/JAHA.121.022123
dc.subject.keyword ST‐segment–elevation myocardial infarction
dc.subject.keyword Drug‐eluting stents
dc.subject.keyword Endothelial dysfunction
dc.subject.keyword Optical coherence tomography
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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