Impact of Statin Treatment on Strut Coverage after Drug-Eluting Stent Implantation

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the effect of statin treatment on strut coverage after drug-eluting stent (DES) implantation. Materials and Methods: In this study, 60 patientswere randomly assigned to undergo sirolimus-eluting stent (SES) or biolimus-eluting stent (BES) implantation, after which patients were randomly treated with pitavastatin 2 mg or pravastatin 20 mg for 6 months. The degree of strut coveragewas assessed by 6-month follow-up optical coherence tomography, which was performed in 52 DES-implanted patients. Results: The percentages of uncovered struts were 19.4±14.7% in pitavastatin-treated patients (n=25) and 19.1±15.2% in pravastatin-treated patients (n=27; p=0.927). A lower percentage of uncovered struts was significantly correlated with a lower follow-up low-density lipoprotein (LDL) cholesterol level (r=0.486; p=0.009) and a greater decline of the LDL cholesterollevel (r=-0.456; p=0.015) in SES-implanted patients, but not in BES-implantedpatients. In SES-implanted patients, the percentage of uncovered struts was significantly lower among those with LDL cholesterol levels of less than 70 mg/dL after 6 months of follow-up (p=0.025), but no significant difference in this variable according to the follow-up LDL cholesterol level was noted among BES-implanted patients (p=0.971). Conclusion: Lower follow-up LDL cholesterol levels,especially those less than 70 mg/dL, might have a protective effect against delayedstrut coverage after DES implantation. This vascular healing effect of lower LDL cholesterol levels could differ according to the DES type.

참고문헌 (Reference)

• 1 Sakamoto T, "Usefulness of hydrophilic vs lipophilic statins after acute myocardial infarction: subanalysis of MUSASHI-AMI" 71 : 1348-1353, 2007
• 2 Mihos CG, "The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in cardiovascular disease: a comprehensive review" 18 : 298-304, 2010
• 3 Tanigawa J, "The influence of strut thickness and cell design on immediate apposition of drug-eluting stents assessed by optical coherence tomography" 134 : 180-188, 2009
• 4 이승률, "Stent Evaluation with Optical Coherence Tomography" 연세대학교의과대학 54 (54): 1075-1083, 2013
• 5 Chevalier B, "Randomized comparison of the Nobori Biolimus A9-eluting coronary stent with the Taxus Liberté paclitaxel-eluting coronary stent in patients with stenosis in native coronary arteries: the NOBORI 1 trial--Phase 2" 2 : 188-195, 2009
• 6 Kim BK, "Randomised comparison of strut coverage between Nobori biolimus-eluting and sirolimus-eluting stents: an optical coherence tomography analysis" 9 : 1389-1397, 2014
• 7 Hayashi T, "Pitavastatin: efficacy and safety in intensive lipid lowering" 8 : 2315-2327, 2007
• 8 Farb A, "Pathological mechaacute nisms of fatal late coronary stent thrombosis in humans" 108 : 1701-1706, 2003
• 9 Finn AV, "Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization" 115 : 2435-2441, 2007
• 10 Saku K, "PATROL Trial Investigators. Randomized head-to-head comparison of pitavastatin, atorvastatin, and rosuvastatin for safety and efficacy (quantity and quality of LDL): the PATROL trial" 75 : 1493-1505, 2011
• 11 Kim JS, "Optical coherence tomography evaluation of zotarolimus-eluting stents at 9-month follow-up: comparison with sirolimus-eluting stents" 95 : 1907-1912, 2009
• 12 Won H, "Optical coherence tomography derived cut-off value of uncovered stent struts to predict adverse clinical outcomes after drug-eluting stent implantation" 29 : 1255-1263, 2013
• 13 Kim BK, "Major determinants for the uncovered stent struts on optical coherence tomography after drug-eluting stent implantation" 28 : 705-714, 2012
• 14 Ishigami K, "Long-term follow-up of neointimal coverage of sirolimus-eluting stents--evaluation with optical coherence tomography" 73 : 2300-2307, 2009
• 15 Jaschke B, "Local statin therapy differentially interferes with smooth mus cle and endothelial cell proliferation and reduces neointima on a drug-eluting stent platform" 68 : 483-492, 2005
• 16 Satoh K, "Lipophilic HMG-CoA reductase inhibitors increase myocardial stunning in dogs" 35 : 256-262, 2000
• 17 Kim BK, "Impact of preprocedural high-sensitivity C-reactive protein levels on uncovered stent struts: an optical coherence tomography study after drug-eluting stent implantation" 34 : 97-101, 2011
• 18 Fukuda D, "Fluvastatin accelerates re-endothelialization impaired by local sirolimus treatment" 612 : 87-92, 2009
• 19 Ostojic M, "First clinical comparison of Nobori -Biolimus A9 eluting stents with Cypher- Sirolimus eluting stents: Nobori Core nine months angiographic and one year clinical outcomes" 3 : 574-579, 2008
• 20 Prati F, "Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis" 31 : 401-415, 2010
• 21 Guagliumi G, "Examination of the in vivo mechanisms of late drug-eluting stent thrombosis: findings from optical coherence tomography and intravascular ultrasound imaging" 5 : 12-20, 2012
• 22 Takano M, "Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation" 99 : 1033-1038, 2007
• 23 Doran H, "Estimating the multilevel Rasch model: with the lme4 package" 20 : 1-18, 2007
• 24 Wolfrum S, "Endothelium-dependent effects of statins" 23 : 729-736, 2003
• 25 Walter DH, "Effects of statins on endothelium and their contribution to neovascularization by mobilization of endothelial progenitor cells" 15 : 235-242, 2004
• 26 Indolfi C, "Effects of hydroxymethylglutaryl coenzyme A reductase inhibitor simvastatin on smooth muscle cell proliferation in vitro and neointimal formation in vivo after vascular injury" 35 : 214-221, 2000
• 27 Bellosta S, "Direct vascular effects of HMG-CoA reductase inhibitors" 137 (137): S101-S109, 1998
• 28 Kim JS, "Different patterns of neointimal coverage between acute coronary syndrome and stable angina after various types of drug-eluting stents implantation; 9-month follow-up optical coherence tomography study" 146 : 341-346, 2011
• 29 Kubo T, "Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris: a serial optical coherence tomography study" 1 : 475-484, 2008
• 30 Werner N, "Bone marrow-derived progenitor cells modulate vascular reendothelialization and neointimal formation: effect of 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition" 22 : 1567-1572, 2002
• 31 Wang TJ, "Atorvastatin accelerates both neointimal coverage and re-endothelialization after sirolimus-eluting stent implantation in a porcine model: new findings from optical coherence tomography and pathology" 76 : 2561-2571, 2012
• 32 Kume T, "Assessment of coronary arterial thrombus by optical coherence tomography" 97 : 1713-1717, 2006
• 33 Davlouros PA, "An optical coherence tomography study of two new generation stents with biodegradable polymer carrier, eluting paclitaxel vs. biolimus-A9" 157 : 341-346, 2012