Abstract
This study was aimed to compare the vascular healing process of a SYNERGY stent with that of a PROMUS PREMIER stent in patients with acute coronary syndrome (ACS). In 71 patients with ACS, undergoing coronary stent implantation using the SYNERGY stent (n = 52) or PROMUS PREMIER stent (n = 19), we measured circulating CD34+/CD133+/CD45null cells and CD34+/KDR+ cells and observed vascular healing at the stented sites using optical coherence tomography (OCT) and coronary angioscopy. On the day 7, circulating CD34+/CD133+/CD45null cells increased in SYNERGY group (P < 0.0001), while it did not change in PROMUS group. The CD34+/KDR+ cells also increased in SYNERGY group (P < 0.0001) but less significantly in the PROMUS group (P < 0.05). The OCT-based neointimal thickness (P < 0.0005) and neointimal coverage rate (P < 0.05) at 12 months were greater in SYNERGY group, compared with PROMUS group. The coronary angioscopy-based neointimal coverage grade at 12 months was also greater in SYNERGY group (P < 0.001). In overall patients, the change in CD34+/KDR+ cells on the day 7 correlated with the OCT-based neointimal thickness at 12 months (R = 0.288, P < 0.05). SYNERGY stent seems to have potential advantages over PROMUS PREMIER stent for ACS patients in terms of vascular healing process at the stented sites.
Highlights
Advances in drug-eluting stent (DES) technology have resulted in reduced target lesion revascularization across broad patient and lesion subsets
The stent implantation procedures were comparable between the two groups, except for the number of stent, which was more in the SYNERGY group than in the PROMUS group (Table 2)
We demonstrated in patients with acute coronary syndrome (ACS) that circulating CD34+/CD133+/CD45null cells and CD34+/kinase insert domain receptor (KDR)+ cells increased significantly on the day 7 in the SYNERGY group, while the CD34+/CD133+/ CD45null cells did not change and the CD34+/KDR+ cells increased less significantly in the PROMUS group
Summary
Advances in drug-eluting stent (DES) technology have resulted in reduced target lesion revascularization across broad patient and lesion subsets. Re-endothelialization and neointimal coverage over the stent struts are essential for vascular healing after stent deployment. A new generation DES stent, SYNERGY (Boston Scientific), consists of a thin strut (74 μm), balloonexpandable platinum-chromium stent platform delivering everolimus from an ultrathin (4 μm) bioabsorbable poly(d,l-lactide-co-glycolic acid) (PLGA) polymer applied to the abluminal surface, has been developed to target optimal vascular healing via its biological and pharmacological characteristics. We observed mobilized progenitor cells and assessed the association between their kinetics and vascular healing at the stent-injured vessel sites in patients with acute coronary syndrome (ACS) who underwent emergent percutaneous coronary intervention (PCI) with coronary stent implantation, and compared the SYNERGY stent with the second generation durable polymer (polyvinylidene difluoride: PVDF) everolimus-eluting stent, PROMUS PREMIER (Boston Scientific) (Fig. 1)
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