Stent edge vascular response and in-stent geometry after aerobic exercise

Maria Dalen Taraldsen,Erik Madssen,Knut Hegbom,Rune Wiseth,Vibeke Videm

doi:10.1007/s12928-020-00655-5

Abstract

The purpose of the present study was to investigate the edge vascular response in patients treated with second-generation drug-eluting stents (DES) after 3 months of aerobic exercise intervention. Thirty-two patients with significant coronary artery disease underwent percutaneous coronary intervention with DES implantation prior to randomization to aerobic interval training (AIT, 14 patients) versus moderate continuous training (MCT, 18 patients). Plaque changes were assessed using grayscale and radiofrequency intravascular ultrasound at baseline and follow-up. The main endpoints were changes in plaque burden and necrotic core content in the 5-mm proximal and distal stent edges. Plaque burden in the distal stent edges decreased significantly in both groups (AIT: − 3.3%; MCT: − 0.4%, p = 0.01 for both), and more in the AIT group (p = 0.048). Necrotic core content decreased significantly in the distal stent edges in both groups (− 2.1 mm3 in AIT, − 0.3 mm3 in MCT, p = 0.01 for both), and more in the AIT group (p = 0.03). There were no significant changes in proximal stent edges or in in-stent geometry at follow-up. In this small study of patients treated with DES implantation, 3 months of aerobic exercise training demonstrated decreased plaque burden and necrotic core content in the distal stent edges, with larger reductions in the AIT group.

Highlights

Percutaneous coronary intervention (PCI) with implantation of second-generation drug-eluting stents (DES) in patients with coronary artery disease (CAD) reduces in-stent restenosis and need for repeat revascularization compared to baremetal stents [1, 2]
The study investigated the effects of two different aerobic exercise interventions, i.e. aerobic interval training (AIT) versus moderate continuous training (MCT), in non-stented coronary segments [12]
There were no significant differences in LDL cholesterol, HDL cholesterol, triglycerides, total cholesterol or HbA1c at follow-up

Summary

Introduction

Percutaneous coronary intervention (PCI) with implantation of second-generation drug-eluting stents (DES) in patients with coronary artery disease (CAD) reduces in-stent restenosis and need for repeat revascularization compared to baremetal stents [1, 2]. Despite the benefits of DES, adverse long-term effects after stenting may occur, such as in-segment restenosis requiring repeat revascularization. A vast amount of evidence has established that high cardiorespiratory fitness measured as peak oxygen uptake (VO2peak) is associated with a reduced risk for CAD and all-cause mortality [5]. Previous studies have shown that aerobic interval training (AIT) is superior to moderate continuous exercise (MCT) with respect to increasing VO2peak in patients with CAD. High-intensity exercise is associated with larger effects on several surrogate markers for atherosclerosis, such as endothelial function and inflammation [6,7,8]

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