Differential responses of local coagulation after implantation of everolimus-eluting and zotarolimus-eluting stents compared with early-generation drug-eluting stents in patients with stable angina

Abstract

Purpose: We have previously demonstrated local persistent hypercoagulability after sirolimus-eluting stent (SES) implantation by measuring plasma prothrombin fragment F1+2 (frF1+2) levels. The aim of this study is to examine local coagulation response after everolimus-eluting stent (EES) and zotarolimus-eluting stent (ZES) implantation compared with early-generation drug-eluting [SES and paclitaxel-eluting stent (PES)] and bare metal stents (BMS). Methods: Eighty-five patients who were treated about eight months earlier with stents to the mid-segment of the left anterior descending coronary artery, with no evidence of restenosis, were studied (EES:12, ZES:15, PES:18, SES:20, and BMS:20). We measured plasma levels of frF1+2 sampled in coronary sinus (CS) and sinus of Valsalva (V). The transcardiac frF1+2 gradients (ΔfrF1+2) were defined as CS level minus V level. Results: A larger percent diameter stenosis (%DS) was observed in the ZES and BMS groups than in the SES (17.1±13.2, 25.1±15.6 vs 7.1±16.5%, p<0.05, respectively). There were no significant differences in %DS among SES, PES, and EES groups (7.1±16.5, 10.5±15.2, 12.6±12.9%, NS). There were no significant differences in ΔfrF1+2 among BMS, ZES, and EES groups (4.7±13.4, 5.5±8.4, 3.3±11.7 pmol/l, NS). The ΔfrF1+2 was smaller in the ZES and EES group, and larger in the PES group than in the SES group (5.5±8.4, 3.3±11.7, 32.3±24.2 vs 23.4±21.1 pmol/l, p<0.05, respectively). The ΔfrF1+2 significantly correlated with the total stent length in the SES group (r=0.53, p<0.05), however, it did not correlate in the EES, ZES, and PES groups. Conclusions: A decreased response of local coagulation after ZES and EES implantation and an increased one after PES implantation were observed, as compared to SES implantation. These findings might be associated with lower strut thickness, unique characteristics of polymer, and lower cytotoxic effect of eluted drug in second-generation drug-eluting stents.