Impact of Combination Therapy with Ezetimibe/Simvastatin Treatment on the Neointimal Response to Biodegradable Polymer Biolimus-Eluting Stent Implantation in Patients with Acute Myocardial Infarction: Serial Assessment with Optical Coherence Tomography

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.

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TCT-461 Association between In-stent Neoatherosclerosis and Restenosis in Patients with Acute Myocardial Infarction at 5-years Follow-up Assessed by Optical Coherence Tomography

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.1631 ◽

2018 ◽

Vol 72 (13) ◽

pp. B185

Author(s):

Masaru Kuroda ◽

Masayuki Kintsu ◽

Mutsuki Kodaira ◽

Yukinori Kato ◽

Kouji Sogabe ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Optical Coherence Tomography ◽

Optical Coherence

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P3385Difference of vascular healing after percutaneous coronary intervention between 4 kinds of new generation drug-eluting stents: an optical coherence tomography analysis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0261 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Matsuhiro ◽

M Nishino ◽

H Nakamura ◽

K Yasumoto ◽

A Tanaka ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Biodegradable Polymer ◽

Neointimal Hyperplasia ◽

Drug Eluting Stents ◽

P Value ◽

Optical Coherence ◽

Durable Polymer ◽

Drug Eluting ◽

New Generation

Abstract Background New generation drug eluting stents (DES) have improved target vessel failure as compared with early generation DES and bare metal stent. Contemporary several new generation DES are different each other regarding strut thickness and drug and polymer type. A little is known about which stent induces a more favorable vascular healing at follow up. Purpose In this study, we compared the vascular healing at 8-month follow up by optical coherence tomography (OCT) between 4 different kinds of new generation DES. Methods We enrolled 112 consecutive patients (121 lesions) who underwent PCI using 4 kinds of new generation DES including biodegradable-polymer everolimus-eluting stents (BP-EES), biodegradable-polymer sirolimus-eluting stents (BP-SES), durable-polymer everolimus-eluting stents (DP-EES) and durable-polymer zotarolimus-eluting stents (DP-ZES) and who underwent 8-month follow up angiogram and OCT between July 2016 and April 2018. We compared the OCT parameters including percentage of covered struts, uncovered struts, well-apposed and uncovered struts, malapposed strut and mean neointimal hyperplasia (NIH) thickness between them. Results BP-EES consisted of 29 lesions, BP-SES consisted of 25 lesions, DP-EES consisted of 38 lesions and DP-ZES consisted of 29 lesions. A total of 734 frames with 5163 struts in BP-EES, 481 frames with 4214 struts in BP-SES, 783 frames with 6119 struts in DP-EES and 583 frames with 4708 struts in DP-ZES were analyzed. As shown in a table, mean NIH thickness was significantly higher in BP-EES and BP-SES. Thus, we compared the OCT parameters between durable-polymer (DP) group including DP-ZES and DP-EES and biodegradable-polymer (BP) group including BP-EES and BP-SES. The percentage of uncovered struts was significantly lower and mean NIH thickness was significantly higher in BP group than DP group. Results of OCT parameters BP-EES (n=29) BP-SES (n=25) DP-EES (n=38) DP-ZES (n=29) P value BP group (n=54) DP group (n=67) P value Covered struts (%) 89.5±13.6 92.4±8.6 85.5±17.5 85.0±17.7 0.29 90.9±11.6 85.3±17.4 0.08 Uncovered struts (%) 8.8±10.8 7.1±8.7 14.5±17.5 15.0±17.7 0.14 8.0±9.9 14.7±17.4 0.03 Well-apposed and uncovered struts (%) 7.9±9.9 5.9±7.7 11.7±13.1 12.3±14.0 0.15 7.0±8.9 11.9±13.4 0.04 Malapposed struts (%) 0.8±1.6 1.3±2.2 2.7±5.8 2.7±4.7 0.33 1.0±1.9 2.7±5.3 0.07 Mean NIH thickness (μm) 102±57 121±48 78±28 88±33 <0.01 111±53 82±31 <0.01 Conclusion The present OCT study demonstrated that delayed neointimal healing characterized by the presence of uncovered struts and lower mean NIH thickness was less common in BP group than DP gruop. Biodegradable-polymer may be more favorable than durable-polymer from the point of view of vascular healing.

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An interesting case of a self-apposing stent implantation in an aneurysmatically dilated artery in acute myocardial infarction with high quality optical coherence tomography images

International Journal of the Cardiovascular Academy ◽

10.1016/j.ijcac.2017.05.007 ◽

2017 ◽

Vol 3 (1-2) ◽

pp. 21-23

Author(s):

Michał Węgiel ◽

Artur Dziewierz ◽

Łukasz Rzeszutko ◽

Dariusz Dudek

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Optical Coherence Tomography ◽

Stent Implantation ◽

Interesting Case ◽

Optical Coherence ◽

High Quality

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Clinical Application of Optical Coherence Tomography in Patients with Non-ST-Elevation Acute Coronary Syndrome Combined with Intermediate Lesions

The Heart Surgery Forum ◽

10.1532/hsf.1447 ◽

2017 ◽

Vol 20 (1) ◽

pp. 032

Author(s):

Hua Yu ◽

Likun Ma ◽

Kefu Feng ◽

Hongwu Chen ◽

Hao Hu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Optical Coherence Tomography ◽

Acute Coronary Syndrome ◽

Drug Treatment ◽

Optical Coherence ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

Objective: This study aimed to evaluate the clinical significance and safety of optical coherence tomography (OCT) in patients with non-ST-elevation acute coronary syndrome (NSTEACS) combined with intermediate lesions.Methods: Sixty-five NSTEACS patients with intermediate lesions confirmed with coronary angiography at our department were included in this study. Among them, 33 patients received only standardized drug treatment (drug group) and the other 32 patients received percutaneous coronary intervention (PCI) according to the OCT examination based on drug treatment (OCT group). Major adverse cardiovascular events (MACEs), revascularization, success rate of OCT examination, related complications, and other patient situations in the two groups during hospitalization and the 12-month follow-up period were compared.Results: No death or stroke occurred in either group during hospitalization and follow-up. In the drug treatment group, six patients experienced frequent angina, and five patients with acute myocardial infarction were rehospitalized and underwent PCI procedures. In the OCT group, although two patients underwent repeat revascularization, no additional acute myocardial infarction events occurred. There was a statistically significant difference between the two groups (P < .01). All patients in the OCT group successfully completed the related vessel examination, and 24 patients underwent PCI procedures because of unstable plaque diagnosed with OCT.Conclusion: OCT-guided PCI is safe and effective for the treatment of patients with NSTEACS combined with intermediate lesions.

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Optical coherence tomography for evaluating Synergy everolimus-eluting stents with biodegradable polymer and Xience durable polymer everolimus-eluting stents following percutaneous coronary intervention in patients with left main coronary artery stenosis

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2017-4-59-68 ◽

2017 ◽

Vol 21 (4) ◽

pp. 59 ◽

Cited By ~ 1

Author(s):

R. U. Ibragimov ◽

A. G. Badoyan ◽

O. V. Krestyaninov ◽

E. A. Pokushalov ◽

I. A. Naryshkin ◽

...

Keyword(s):

Myocardial Infarction ◽

Optical Coherence Tomography ◽

Coronary Artery ◽

Conflict Of Interest ◽

Biodegradable Polymer ◽

Left Main Coronary Artery ◽

Optical Coherence ◽

Left Main ◽

Durable Polymer

Aim. The development of on a new generation of stents with abluminal biodegradable polymer is aimed at accelerating the neointimal growth and reducing the inflammatory response of the vascular wall. This article presents an analysis of healing characteristics, as assessed by optical coherence tomography (OCT), of ultrathin Synergy everolimus-eluting stent with biodegradable polymer and Xience everolimus-eluting stent with durable polymer three months after implantation. Methods. In this prospective, single-center study fifty patients with significant stenosis of the left main coronary artery were randomized in 2 groups for implantation of everolimus-eluting stents with durable polymer (Xience) or abluminal biodegradable polymer (Synergy). After three months all patients underwent control coronarography supported by optical coherence tomography. A Neointimal Healing Score (NIH Score) obtained at three months after stent implantation by means of optical coherence tomography was the primary endpoint. Such OCT data as percentage of uncovered or malapposed struts only and presence of both malapposed and uncovered struts were planned as the secondary endpoints. To study the freedom from adverse events, one composite endpoint including myocardial infarction, repeat left coronary artery revascularization and death within 12 months after the procedure was determined. Results. There were no significant differences in the NIH score (primary endpoint) in two groups (25.6±12.3 in Xience vs 32.5±20.3 in Synergy, respectively; p = 0.12). The struts of both types of stents showed statistically similar coverage and apposition at 3-month OCT follow-up: percentage of uncovered struts only was 6.3±3.9 and 9.9±7.8 in Xience and Synergy groups, respectively (p = 0.098) and malapposed struts only 0.25±0.5 vs 0.37±0.5; p = 0.628. The presence of both malapposed and uncovered struts was 4.9±3.8 and 5.1±4.5 in two groups and didn’t differ statistically (p = 0.92). During 12-month follow-up, two cases of stent thrombosis were recorded (one in each group), which required repeat revascularization. In addition, one case of myocardial infarction related to the right coronary artery occurred in the Synergy group. Conclusion. The Synergy everolimus-eluting stent with abluminal biodegradable polymer has a healing profile comparable to that of Xience everolimus-eluting stent with durable polymer with a low rate of uncovered and malapposed struts at 3-month follow-up. A low incidence of adverse events in both groups during 12-month follow-up indicates the safety of the stents under study.Received 18 September 2017. Revised 13 December 2017. Accepted 15 December 2017.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions All authors contributed equally to the work.

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