Sirolimus-Eluting Stent implantation aggravates endothelial vasomotor dysfunction in the infarct-related coronary artery in patients with acute myocardial infarction
Sirolimus-Eluting Stent implantation aggravates endothelial vasomotor dysfunction in the infarct-related coronary artery in patients with acute myocardial infarction
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DOI：
10.1016/j.jacc.2007.06.031
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发表时间：
2007-10-02
影响因子：
24
通讯作者：
Kugiyama, Kiyotaka
中科院分区：
文献类型：
--
作者：
Obata, Iyun-ei;Kitta, Yoshinobu;Kugiyama, Kiyotaka
目的探讨西罗莫司洗脱支架（SES）植入对急性心肌梗死（AMI）患者冠状动脉阻力和心外膜梗死相关血管内皮功能障碍的影响。西罗莫司洗脱支架植入抑制再内皮化的网站stenting.Methods本研究包括29例首次AMI由于闭塞的左前降支冠状动脉（LAD）和成功的再灌注治疗使用SES（n = 13）或裸金属支架（BMS）（n = 16）。AMI后2周，测量SES部署部位远端的心外膜段直径和LAD中响应于冠状动脉内灌注乙酰胆碱的冠状动脉血流量。结果SES组心外膜冠状动脉对乙酰胆碱的反应较BMS组严重，SES组对乙酰胆碱反应的冠状动脉血流量增加低于BMS组。血管内皮生长因子水平在AN中显着低于AO中的SES组，但不是在BMS group.Conclusions在AMI的过程中，SES植入不利地影响内皮依赖性血管功能的阻力和心外膜冠状动脉缺血再灌注后，与心肌VEGF分泌减少。
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 AN 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.