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Comparison of neointimal hyperplasia and peri-stent vascular remodeling after implantation of everolimus-eluting versus sirolimus-eluting stents: intravascular ultrasound results from the EXCELLENT study

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Abstract

This study was designed to compare neointimal hyperplasia and peri-stent arterial remodeling after implantation of everolimus-eluting stent (EES) versus sirolimus-eluting stent (SES) using intravascular ultrasound (IVUS). The study population was a subgroup of 278 patients from the EXCELLENT trial, a randomized study comparing EES to SES in de novo coronary artery lesions (total n = 1,443, 3:1 randomization) who underwent post-PCI and 9-month follow-up IVUS evaluation. There were 209 patients in the EES group and 69 in the SES group. Baseline clinical and angiographic characteristics were similar between the two groups except for age and target lesion locations. At 9 months, percent neointimal volume obstruction did not differ between EES and SES (2.6 ± 4.0 % vs. 2.5 ± 4.8 %, p = 0.814). However, the relative change in the vessel (4.3 ± 13.7 % vs. 8.8 ± 18.6 %, p = 0.030) and plaque volume index (4.2 ± 17.4 % vs. 10.5 ± 22.3 %, p = 0.016) of the stented segment from post-intervention to follow-up was significantly less with EES than with SES. In addition, positive peri-stent vascular remodeling defined as an increase in vessel volume index >10 % (27.8 vs. 42.0 %, p = 0.027) and late acquired stent malapposition (LASM, 1.9 vs. 15.9 %, p < 0.001) were observed less frequently with EES than SES. EES and SES were similarly effective in reducing neointimal hyperplasia. However, positive peri-stent vascular remodeling and LASM occurred less frequently with EES than SES.

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References

  1. Costa RA, Lansky AJ, Mintz GS et al (2005) Angiographic results of the first human experience with everolimus-eluting stents for the treatment of coronary lesions (the FUTURE I trial). Am J Cardiol 95:113–116

    Article  PubMed  CAS  Google Scholar 

  2. Serruys PW, Ong AT, Piek JJ et al (2005) A randomized comparison of a durable polymer Everolimus-eluting stent with a bare metal coronary stent: the SPIRIT first trial. EuroIntervention 1:58–65

    PubMed  Google Scholar 

  3. Applegate RJ, Yaqub M, Hermiller JB et al (2011) Long-term (three-year) safety and efficacy of everolimus-eluting stents compared to paclitaxel-eluting stents (from the SPIRIT III Trial). Am J Cardiol 107:833–840

    Article  PubMed  CAS  Google Scholar 

  4. Park KW, Yoon JH, Kim JS et al (2009) Efficacy of Xience/promus versus Cypher in rEducing Late Loss after stENTing (EXCELLENT) trial: study design and rationale of a Korean multicenter prospective randomized trial. Am Heart J 157(811–817):e811

    Article  Google Scholar 

  5. Park KW, Chae IH, Lim DS et al (2011) Everolimus-eluting versus sirolimus-eluting stents in patients undergoing percutaneous coronary intervention the EXCELLENT (Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting) Randomized Trial. J Am Coll Cardiol 58:1844–1854

    Article  PubMed  CAS  Google Scholar 

  6. Moses JW, Leon MB, Popma JJ et al (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N E J Med 349:1315–1323

    Article  CAS  Google Scholar 

  7. Schomig A, Dibra A, Windecker S et al (2007) A meta-analysis of 16 randomized trials of sirolimus-eluting stents versus paclitaxel-eluting stents in patients with coronary artery disease. J Am Coll Cardiol 50:1373–1380

    Article  PubMed  Google Scholar 

  8. Park DW, Kim YH, Yun SC et al (2010) Comparison of zotarolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for coronary revascularization: the ZEST (comparison of the efficacy and safety of zotarolimus-eluting stent with sirolimus-eluting and paclitaxel-eluting stent for coronary lesions) randomized trial. J Am Coll Cardiol 56:1187–1195

    Article  PubMed  Google Scholar 

  9. Rasmussen K, Maeng M, Kaltoft A et al (2010) Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary stents in routine clinical care (SORT OUT III): a randomised controlled superiority trial. Lancet 375:1090–1099

    Article  PubMed  CAS  Google Scholar 

  10. Mintz GS, Nissen SE, Anderson WD et al (2001) American College of cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS). A report of the American College of cardiology task force on clinical expert consensus documents. J Am Coll Cardiol 37:1478–1492

    Article  PubMed  CAS  Google Scholar 

  11. Hong MK, Mintz GS, Lee CW et al (2006) Late stent malapposition after drug-eluting stent implantation: an intravascular ultrasound analysis with long-term follow-up. Circulation 113:414–419

    Article  PubMed  CAS  Google Scholar 

  12. Hong MK, Mintz GS, Lee CW et al (2004) Incidence, mechanism, predictors, and long-term prognosis of late stent malapposition after bare-metal stent implantation. Circulation 109:881–886

    Article  PubMed  Google Scholar 

  13. Stone GW, Midei M, Newman W et al (2008) Comparison of an everolimus-eluting stent and a paclitaxel-eluting stent in patients with coronary artery disease: a randomized trial. JAMA 299:1903–1913

    Article  PubMed  CAS  Google Scholar 

  14. de Waha A, Dibra A, Byrne RA et al (2011) Everolimus-eluting versus sirolimus-eluting stents: a meta-analysis of randomized trials. Circ Cardiovasc Interv 4:371–377

    Article  PubMed  Google Scholar 

  15. Kaiser C, Galatius S, Erne P et al (2010) Drug-eluting versus bare-metal stents in large coronary arteries. N E J Med 363:2310–2319

    Article  CAS  Google Scholar 

  16. Kim WJ, Lee SW, Park SW et al (2011) Randomized comparison of everolimus-eluting stent versus sirolimus-eluting stent implantation for de novo coronary artery disease in patients with diabetes mellitus (ESSENCE-DIABETES): results from the ESSENCE-DIABETES trial. Circulation 124:886–892

    Article  PubMed  CAS  Google Scholar 

  17. Byrne RA, Kastrati A, Massberg S et al (2011) Biodegradable polymer versus permanent polymer drug-eluting stents and everolimus- versus sirolimus-eluting stents in patients with coronary artery disease: 3-year outcomes from a randomized clinical trial. J Am Coll Cardiol 58:1325–1331

    Article  PubMed  Google Scholar 

  18. Okkels Jensen L, Thayssen P, Hansen HS et al (2012) Randomized comparison of everolimus-eluting and sirolimus-eluting stents in patients treated with percutaneous coronary intervention: the Scandinavian organization for randomized trials with clinical outcome IV (SORT OUT IV). Circulation 125:1246–1255

    Article  CAS  Google Scholar 

  19. Guo N, Maehara A, Mintz GS et al (2010) Incidence, mechanisms, predictors, and clinical impact of acute and late stent malapposition after primary intervention in patients with acute myocardial infarction: an intravascular ultrasound substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Circulation 122:1077–1084

    Article  PubMed  Google Scholar 

  20. Nakazawa G, Finn A, John M, Kolodgie F, Virmani R (2007) The significance of preclinical evaluation of sirolimus-, paclitaxel-, and zotarolimus-eluting stents. Am J Cardiol 100:S36–S44

    Article  Google Scholar 

  21. Miyazawa A, Ako J, Hongo Y et al (2008) Comparison of vascular response to zotarolimus-eluting stent versus sirolimus-eluting stent: intravascular ultrasound results from ENDEAVOR III. Am Heart J 155:108–113

    Article  PubMed  CAS  Google Scholar 

  22. Sakurai R, Bonneau HN, Honda Y, Fitzgerald PJ (2007) Intravascular ultrasound findings in ENDEAVOR II and ENDEAVOR III. Am J Cardiol 100:71M–76M

    Article  PubMed  CAS  Google Scholar 

  23. Rathore S, Terashima M, Habara M et al (2009) Incomplete stent apposition after coronary stent implantation: myth or reality? J Interv Cardiol 22:341–349

    Article  PubMed  Google Scholar 

  24. Hassan AK, Bergheanu SC, Stijnen T et al (2010) Late stent malapposition risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis. Eur Heart J 31:1172–1180

    Article  PubMed  CAS  Google Scholar 

  25. Cook S, Wenaweser P, Togni M et al (2007) Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation 115:2426–2434

    Article  PubMed  CAS  Google Scholar 

  26. Nakazawa G, Finn AV, Vorpahl M, Ladich ER, Kolodgie FD, Virmani R (2011) Coronary responses and differential mechanisms of late stent thrombosis attributed to first-generation sirolimus- and paclitaxel-eluting stents. J Am Coll Cardiol 57:390–398

    Article  PubMed  CAS  Google Scholar 

  27. Iakovou I, Schmidt T, Bonizzoni E et al (2005) Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293:2126–2130

    Article  PubMed  CAS  Google Scholar 

  28. Hasebe T, Shimada A, Suzuki T et al (2006) Fluorinated diamond-like carbon as antithrombogenic coating for blood-contacting devices. J Biomed Mater Res, Part A 76:86–94

    Article  Google Scholar 

  29. Briguori C, Sarais C, Pagnotta P et al (2002) In-stent restenosis in small coronary arteries: impact of strut thickness. J Am Coll Cardiol 40:403–409

    Article  PubMed  Google Scholar 

  30. Kastrati A, Mehilli J, Dirschinger J et al (2001) Intracoronary stenting and angiographic results: strut thickness effect on restenosis outcome (ISAR-STEREO) trial. Circulation 103:2816–2821

    Article  PubMed  CAS  Google Scholar 

  31. Baber U, Mehran R, Sharma SK et al (2011) Impact of the everolimus-eluting stent on stent thrombosis: a meta-analysis of 13 randomized trials. J Am Coll Cardiol 58:1569–1577

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was partly supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (No. A085012, A102064, and A110879); a grant from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (No. A085136); and the Cardiovascular Research Center, Seoul, Korea.

Conflict of interest

The authors also received research grants from Abbott Vascular Korea and Boston Scientific Korea. The funding sources of the study had no role in study design, data collection, monitoring, analysis, interpretation, or writing of the manuscript.

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Authors and Affiliations

  1. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Young-Guk Ko, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Donghoon Choi, Myeong-Ki Hong & Yangsoo Jang

  2. Samsung Medical Center, Sung-Kyun-Kwan University, Seoul, Korea

    Hyeon-Cheol Gwon

  3. Gil Medical Center, Gachon University, Incheon, Korea

    Taehoon Ahn

  4. Seoul National University Bundang Hospital, Sungnam, Korea

    In-Ho Chae

  5. Wonju Severance Hospital, Yonsei University, Wonju, Korea

    Jung-Han Yoon

  6. Seoul National University Main Hospital, Seoul, Korea

    Hyo-Soo Kim

  7. Severance Biomedical Science Institute, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Yangsoo Jang

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  1. Young-Guk Ko
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  2. Dong-Ho Shin
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Correspondence to Yangsoo Jang.

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Ko, YG., Shin, DH., Kim, JS. et al. Comparison of neointimal hyperplasia and peri-stent vascular remodeling after implantation of everolimus-eluting versus sirolimus-eluting stents: intravascular ultrasound results from the EXCELLENT study. Int J Cardiovasc Imaging 29, 1229–1236 (2013). https://doi.org/10.1007/s10554-013-0199-5

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  • DOI: https://doi.org/10.1007/s10554-013-0199-5

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