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急性冠脉综合征

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Evaluation and Management of Nonculprit Lesions in STEMI Early versus delayed invasive intervention in acute coronary syndromes Decreased inspired oxygen stimulates de novo formation of coronary collaterals in adult heart Effect of Pre-Hospital Crushed Prasugrel Tablets in Patients with STEMI Planned for Primary Percutaneous Coronary Intervention: The Randomized COMPARE CRUSH Trial Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI Heart Regeneration by Endogenous Stem Cells and Cardiomyocyte Proliferation: Controversy, Fallacy, and Progress New technologies for intensive prevention programs after myocardial infarction: rationale and design of the NET-IPP trial Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI Comparison in prevalence, predictors, and clinical outcome of VSR versus FWR after acute myocardial infarction: The prospective, multicenter registry MOODY trial-heart rupture analysis Coronary CT Angiography and 5-Year Risk of Myocardial Infarction

Clinical Trial2018 Aug 27;11(16):1559-1571.

JOURNAL:JACC Cardiovasc Interv. Article Link

Long-Term Coronary Functional Assessment of the Infarct-Related Artery Treated With Everolimus-Eluting Bioresorbable Scaffolds or Everolimus-Eluting Metallic Stents: Insights of the TROFI II Trial

Gomez-Lara J, Brugaletta S, Ortega-Paz L et al. Keywords: ST-segment elevation myocardial infarction; bioresorbable vascular scaffolds; drug-eluting stent(s); endothelial dysfunction; optical coherence tomography

ABSTRACT


OBJECTIVES - The study sought to compare the vasomotor and microcirculatory function of the infarct-related artery (IRA) between bioresorbable vascular scaffolds (BVS) and everolimus-eluting stents (EES) at 3 years.


BACKGROUND - The ABSORB STEMI TROFI II study showed similar outcomes between BVS and EES in the context of ST-segment elevation myocardial infarction at 3 years.

METHODS - Sixty-three consecutive event-free patients of the randomized TROFI II study were screened to undergo coronary angiography with vasomotor, microcirculatory, and optical coherence tomography (OCT) examination at 3 years. Vasomotion was defined as >4% change in mean lumen diameter to acetylcholine (ACH) and nitroglycerin as assessed by quantitative angiography. Microcirculatory examination was performed with pressure or thermodilution techniques.

RESULTS - A total of 38 patients (20 BVS and 18 EES) were included. At 3 years, ≥60% of patients exhibited paradoxical vasoconstriction to ACH in the periscaffold or stent segments. Vasoconstriction to ACH and vasodilatation to nitroglycerin were more often observed in the scaffold or stent segment with BVS than with EES (77.8% vs. 25.0%; p = 0.008 and 61.1% vs. 18.8%; p = 0.018). The IRA-depending microcirculation showed similar index of resistance (23.8 vs. 22.4; p = 0.781), coronary flow reserve (2.4 vs. 1.9; p = 0.523), fractional flow reserve (0.91 vs. 0.93; p = 0.317), and absolute flow (135.5 ml/min vs. 147.3 ml/min; p = 0.791). OCT showed remaining strut footprints and larger number of intraluminal scaffold dismantling (26.3% vs. 0%; p = 0.049) in the BVS group.

CONCLUSIONS - Both endothelium-dependent and -independent vasomotion of the IRA were more evident with BVS, as compared with EES, at 3 years. Functional microcirculatory parameters were mostly adequate and similar between BVS and EES. Clinical implications of these findings warrant further investigations.

Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.