Ju-Seung Kwun, Jin Joo Park, Si-Hyuck Kang, Sun-Hwa Kim, Chang-Hwan Yoon, Jung-Won Suh, Tae-Jin Youn, Kwang Soo Cha, Seung-Hwan Lee, Bum-Kee Hong, Seung-Woon Rha, Woong Chol Kang, In-Ho Chae
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引用次数: 0
Abstract
Background: Coronary artery disease is a global health concern that necessitates treatments, such as percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Recent advancements in biodegradable polymer-coated DES have improved long-term outcomes by reducing neointimal hyperplasia. Superior long-term outcomes in patients with ultrathin-strut sirolimus-eluting Orsiro stent (BP-SES) compared with those with thick-strut biolimus-eluting BioMatrix stent (BP-BES) have been shown. This study aimed to explore the mechanisms underlying these differences by using quantitative coronary angiography (QCA) and optical coherence tomography (OCT).
Methods: This sub-analysis of the BIODEGRADE trial, a prospective, randomized, multi-center study, compared BP-SES and BP-BES in patients who underwent PCI between July 2014 and September 2017. Patients with positive stress test results, ischemic symptoms, or those who consented to routine follow-up angiography were included. QCA and OCT were used to evaluate the lumen diameter, cross-sectional areas and stent apposition or coverage. OCT images were analyzed at 1 mm intervals within 5 mm proximal and distal to the stented segment.
Results: Of the 2,341 patients, 689 underwent follow-up angiography between 18- and 36-months post-PCI, and 929 stents were analyzed via QCA. OCT images of 61 participants were available. The BP-SES group exhibited a significantly larger minimal lumen diameter and reduced late lumen loss compared to the BP-BES group (0.34 ± 0.45 mm vs. 0.42 ± 0.44 mm, P = 0.005). OCT analysis showed significantly less neointimal hyperplasia in the BP-SES group (0.04 ± 0.4 mm2 vs. 0.64 ± 0.54 mm2, P < 0.001), with no significant differences in stent strut coverage or inflammation markers, than in the BP-BES group.
Conclusions: QCA and OCT analyses revealed less neointimal growth with BP-SES than with BP-BES, without delayed healing or increased inflammation. These findings underscore the importance of stent design characteristics and suggest that thinner struts may enhance clinical success by reducing restenosis and improving long-term vessel patency.
背景：冠状动脉疾病是一个全球性的健康问题，需要治疗，如经皮冠状动脉介入治疗（PCI）与药物洗脱支架（DES）。生物可降解聚合物涂层DES的最新进展通过减少内膜增生改善了长期疗效。超薄支架西罗莫司洗脱Orsiro支架（BP-SES）患者的长期预后优于厚支架生物基质支架（BP-BES）患者。本研究旨在通过定量冠状动脉造影（QCA）和光学相干断层扫描（OCT）探讨这些差异的机制。方法：bio降解试验是一项前瞻性、随机、多中心研究，对2014年7月至2017年9月期间接受PCI治疗的患者进行BP-SES和BP-BES的亚分析。患者有阳性的压力测试结果，缺血性症状，或那些同意常规随访血管造影。使用QCA和OCT评估管腔直径、横截面积和支架贴置或覆盖。在支架段近端和远端5毫米内，每隔1毫米分析OCT图像。结果：在2341例患者中，689例在pci术后18至36个月期间接受了随访血管造影，929例通过QCA对支架进行了分析。61名参与者的OCT图像可用。与BP-BES组相比，BP-SES组表现出更大的最小管腔直径和更少的晚期管腔损失（0.34±0.45 mm比0.42±0.44 mm, P = 0.005）。OCT分析显示BP-SES组新生内膜增生明显减少（0.04±0.4 mm2 vs. 0.64±0.54 mm2， P）。结论：QCA和OCT分析显示BP-SES组新生内膜增生少于BP-BES组，且未延迟愈合或增加炎症。这些发现强调了支架设计特征的重要性，并表明更薄的支架可以通过减少再狭窄和改善长期血管通畅来提高临床成功率。临床试验注册：https://clinicaltrials.gov/study/NCT02299011 （NCT02299011）。
期刊介绍：
Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers?
At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.
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