Abstract
The aim of this study was to compare the neointimal response at 12-month follow-up between ezetimibe/simvastatin (Vytorin, manufactured by Merck) 10/10 mg and Vytorin 10/40 mg after biodegradable polymer Biolimus-eluting stent (BP-BES) implantation in patients with acute myocardial infarction (AMI). A total of 20 patients requiring revascularization were randomly assigned to receive either Vytorin 10/10 mg (n = 9) or Vytorin 10/40 mg (n = 11). Baseline optical coherence tomography (OCT) was performed after stent implantation, and follow-up OCT was scheduled at 12 months. We performed follow-up OCT in 18 patients (Vytorin 10/10 mg (n = 9) or Vytorin 10/40 mg (n = 9)). A total of 842 frames and 8552 struts were analyzed at initial and follow-up OCT. At follow-up, the percentage of uncovered struts was not significantly different between both groups (6.61 ± 10.29% vs. 7.57 ± 6.45%, p = 0.815). The percentage of malapposed struts was also similar between both groups (0.69 ± 1.58% vs. 1.55 ± 2.72%, respectively, p = 0.422). Mean percent neointimal hyperplasia area was not significantly different between both groups (6.53 ± 3.26% vs. 6.37 ± 8.96%, p = 0.961). This OCT study showed that both high- and moderate-intensity dosing of Vytorin was associated with relatively lower percentages of uncovered struts and malapposed struts after Biolimus A9-eluting stent implantation in patients with AMI.
Highlights
Despite the fact that drug-eluting stent (DES) implantation has demonstrated marked reduction in restenosis as compared with the bare metal stent (BMS), the occurrence of late stent thrombosis has been a major concern [1,2,3,4]
Study Design and Study Population. This was a prospective, single-centre, randomized study, designed to compare the neointimal response according to the different doses of Vytorin after biodegradable polymer Biolimus-eluting stent (BP-BES) implantation in patients with acute myocardial infarction (AMI), including stent thrombosis (ST)-elevation myocardial infarction (STEMI)
During follow-up angiography with optical coherence tomography (OCT), assessment was completely achieved in 18 subjects, nine of the Vytorin 10/10 mg group and nine of the Vytorin 10/40 mg group
Summary
Despite the fact that drug-eluting stent (DES) implantation has demonstrated marked reduction in restenosis as compared with the bare metal stent (BMS), the occurrence of late stent thrombosis has been a major concern [1,2,3,4]. Animal studies have demonstrated that DES induced greater fibrin deposition, late neointimal thickening, and delayed endothelialisation compared with BMS [5]. Incomplete neointimal coverage of covered struts, the most powerful indicator of endothelialisation, was the best morphometric predictor of late stent thrombosis in a pathologic study [6]. Sci. 2018, 8, 1968 with very late stent thrombosis, occurring beyond one year after DES implantation [7,8]. Assessment of appropriate endothelialisation and late apposition status of DES is the key factor for the prevention of stent thrombosis
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