Everolimus-eluting stent suppresses chronic inflammatory reaction compared with bare metal stent in off-label patients

Abstract

Background: Drug-eluting stents (DES) have been shown to be very effective in reducing target vessel revascularization to prevent restenosis as compared with bare metal stents (BMS). DES have been increasingly used in indications, but their safety and efficacy have not been clarified. Therefore, MULTI-LINK VISION® cobalt chromium stent (CCS) and the XIENCE V® everolimus eluting stent (EES) which have the same CCS platform were compared to examine systemic inflammation markers, outcomes, and complications in patients with indications. Methods: Consecutive 365 patients (445 lesions) in off-label indications, who were treated with EES (201 patients, 255 lesions) and CCS (164 patients, 190 lesions) were evaluated. Off-label indications included ostial, left main, long, bifurcation, and in-stent restenotic lesions, chronic total occlusions (CTO), small vessels, and ST-segment elevation myocardial infarction (STEMI). One year outcomes and 9-month angiographic follow-up results were analyzed. Logarithm high-sensitivity CRP (Log hs-CRP) and IL-6 were also measured before and 9-months after PCI. Results: Age, prevalence of diabetes, and the lesions of restenosis, CTO, small vessel, diffuse long and bifurcation were significantly higher in the EES than in the CCS group. In contrast, presence of thrombus in the culprit lesion and STEMI were significantly lower in the EES than in the CCS group. Lesion length (p=0.008) and stent length (p=0.006) were longer in the EES than in the CCS group, while reference diameter was smaller in the EES than in the CCS group (p=0.008). Initial success rate was similar in both groups. The incidence of MACE (4.4% vs. 17.7%, p<0.05), TLR (2.4% vs. 12.6%, p<0.05), ST (1.2% vs. 3.7%, p<0.05) and MI (1.2% vs. 4.9%, p<0.05) were significantly lower in the EES than in the CCS group, respectively, while the incidence of cardiac death did not differ. Log hs-CRP and IL-6 significantly decreased in the EES group 9-months after PCI as compared with before PCI (Log hs-CRP: 3.98±0.25→2.99±0.38, IL-6; 6.66±3.27→3.80±2.44, p<0.01), but not the CCS group. Conclusion: Patients with EES in off label indications including STEMI were associated with favorable reduction of repeat revascularization with prevention of restenosis and outcomes which might be induced by the stronger continuous anti-inflammatory effect of EES compared to CCS.