The long-term effect of coronary stenting on epicardial and microvascular endothelial function

Seong Hoon Lim, Andreas J. Flammer, Myeong Ho Yoon, Ryan J. Lennon, Rajiv Gulati, Verghese Mathew, Charanjit Rihal, Lilach O Lerman, Amir Lerman

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Coronary stents, drug-eluting stents in particular, have been linked to coronary epicardial endothelial dysfunction after implantation. However, less is known about their impact on coronary microvascular function and their long-term effects on the vasculature. Methods and Results: We evaluated 71 patients (mean age, 53.0±10.1 years) with chest pain and angiographically nonsignificant coronary artery disease 17.1±17.1 months after left anterior descending coronary artery stenting. Seventy-one age- and sex-matched patients (mean age, 53.0±10.3 years) with chest pain but no prior coronary intervention served as controls. Coronary blood flow in response to the endothelium-dependent vasodilator acetylcholine as well as the microvascular (endothelium-independent) coronary flow reserve in response to intracoronary adenosine were evaluated. Quantitative coronary angiography was used to study epicardial diameter changes to acetylcholine. Microcirculatory function was not significantly different between the stenting and control groups (median [interquartile range] coronary flow reserve, 2.9 [2.5-3.4] versus 3.0 [2.4-3.4] mL/min, P=0.24; change of coronary blood flow, 34.9% [?34.4% to 90.0%] versus 54.7% [?5.6% to 104.6%], P=0.18). Both groups exhibited epicardial endothelial dysfunction (?23.0% [-47.4% to ?7.6%] versus ?20.0% [-40.0% to 0.0%], P=0.4). Results did not differ between patients with drug-eluting stents (n=46) and patients with bare-metal stents (n=24). Conclusions: This study demonstrates that in patients with coronary arteries in which a stent has been placed, coronary microcirculatory and epicardial vascular function are not significantly different from that of an age- and sex-matched population with similar symptoms but nonsignificant coronary artery disease.

Original languageEnglish (US)
Pages (from-to)523-529
Number of pages7
JournalCirculation: Cardiovascular Interventions
Volume5
Issue number4
DOIs
StatePublished - Aug 2012

Fingerprint

Stents
Drug-Eluting Stents
Chest Pain
Acetylcholine
Coronary Artery Disease
Coronary Vessels
Endothelium-Dependent Relaxing Factors
Coronary Angiography
Adenosine
Endothelium
Blood Vessels
Metals
Control Groups
Population

Keywords

  • Coronary disease
  • Endothelium
  • Microcirculation
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The long-term effect of coronary stenting on epicardial and microvascular endothelial function. / Lim, Seong Hoon; Flammer, Andreas J.; Yoon, Myeong Ho; Lennon, Ryan J.; Gulati, Rajiv; Mathew, Verghese; Rihal, Charanjit; Lerman, Lilach O; Lerman, Amir.

In: Circulation: Cardiovascular Interventions, Vol. 5, No. 4, 08.2012, p. 523-529.

Research output: Contribution to journalArticle

Lim, Seong Hoon ; Flammer, Andreas J. ; Yoon, Myeong Ho ; Lennon, Ryan J. ; Gulati, Rajiv ; Mathew, Verghese ; Rihal, Charanjit ; Lerman, Lilach O ; Lerman, Amir. / The long-term effect of coronary stenting on epicardial and microvascular endothelial function. In: Circulation: Cardiovascular Interventions. 2012 ; Vol. 5, No. 4. pp. 523-529.
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abstract = "Background: Coronary stents, drug-eluting stents in particular, have been linked to coronary epicardial endothelial dysfunction after implantation. However, less is known about their impact on coronary microvascular function and their long-term effects on the vasculature. Methods and Results: We evaluated 71 patients (mean age, 53.0±10.1 years) with chest pain and angiographically nonsignificant coronary artery disease 17.1±17.1 months after left anterior descending coronary artery stenting. Seventy-one age- and sex-matched patients (mean age, 53.0±10.3 years) with chest pain but no prior coronary intervention served as controls. Coronary blood flow in response to the endothelium-dependent vasodilator acetylcholine as well as the microvascular (endothelium-independent) coronary flow reserve in response to intracoronary adenosine were evaluated. Quantitative coronary angiography was used to study epicardial diameter changes to acetylcholine. Microcirculatory function was not significantly different between the stenting and control groups (median [interquartile range] coronary flow reserve, 2.9 [2.5-3.4] versus 3.0 [2.4-3.4] mL/min, P=0.24; change of coronary blood flow, 34.9{\%} [?34.4{\%} to 90.0{\%}] versus 54.7{\%} [?5.6{\%} to 104.6{\%}], P=0.18). Both groups exhibited epicardial endothelial dysfunction (?23.0{\%} [-47.4{\%} to ?7.6{\%}] versus ?20.0{\%} [-40.0{\%} to 0.0{\%}], P=0.4). Results did not differ between patients with drug-eluting stents (n=46) and patients with bare-metal stents (n=24). Conclusions: This study demonstrates that in patients with coronary arteries in which a stent has been placed, coronary microcirculatory and epicardial vascular function are not significantly different from that of an age- and sex-matched population with similar symptoms but nonsignificant coronary artery disease.",
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AU - Flammer, Andreas J.

AU - Yoon, Myeong Ho

AU - Lennon, Ryan J.

AU - Gulati, Rajiv

AU - Mathew, Verghese

AU - Rihal, Charanjit

AU - Lerman, Lilach O

AU - Lerman, Amir

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N2 - Background: Coronary stents, drug-eluting stents in particular, have been linked to coronary epicardial endothelial dysfunction after implantation. However, less is known about their impact on coronary microvascular function and their long-term effects on the vasculature. Methods and Results: We evaluated 71 patients (mean age, 53.0±10.1 years) with chest pain and angiographically nonsignificant coronary artery disease 17.1±17.1 months after left anterior descending coronary artery stenting. Seventy-one age- and sex-matched patients (mean age, 53.0±10.3 years) with chest pain but no prior coronary intervention served as controls. Coronary blood flow in response to the endothelium-dependent vasodilator acetylcholine as well as the microvascular (endothelium-independent) coronary flow reserve in response to intracoronary adenosine were evaluated. Quantitative coronary angiography was used to study epicardial diameter changes to acetylcholine. Microcirculatory function was not significantly different between the stenting and control groups (median [interquartile range] coronary flow reserve, 2.9 [2.5-3.4] versus 3.0 [2.4-3.4] mL/min, P=0.24; change of coronary blood flow, 34.9% [?34.4% to 90.0%] versus 54.7% [?5.6% to 104.6%], P=0.18). Both groups exhibited epicardial endothelial dysfunction (?23.0% [-47.4% to ?7.6%] versus ?20.0% [-40.0% to 0.0%], P=0.4). Results did not differ between patients with drug-eluting stents (n=46) and patients with bare-metal stents (n=24). Conclusions: This study demonstrates that in patients with coronary arteries in which a stent has been placed, coronary microcirculatory and epicardial vascular function are not significantly different from that of an age- and sex-matched population with similar symptoms but nonsignificant coronary artery disease.

AB - Background: Coronary stents, drug-eluting stents in particular, have been linked to coronary epicardial endothelial dysfunction after implantation. However, less is known about their impact on coronary microvascular function and their long-term effects on the vasculature. Methods and Results: We evaluated 71 patients (mean age, 53.0±10.1 years) with chest pain and angiographically nonsignificant coronary artery disease 17.1±17.1 months after left anterior descending coronary artery stenting. Seventy-one age- and sex-matched patients (mean age, 53.0±10.3 years) with chest pain but no prior coronary intervention served as controls. Coronary blood flow in response to the endothelium-dependent vasodilator acetylcholine as well as the microvascular (endothelium-independent) coronary flow reserve in response to intracoronary adenosine were evaluated. Quantitative coronary angiography was used to study epicardial diameter changes to acetylcholine. Microcirculatory function was not significantly different between the stenting and control groups (median [interquartile range] coronary flow reserve, 2.9 [2.5-3.4] versus 3.0 [2.4-3.4] mL/min, P=0.24; change of coronary blood flow, 34.9% [?34.4% to 90.0%] versus 54.7% [?5.6% to 104.6%], P=0.18). Both groups exhibited epicardial endothelial dysfunction (?23.0% [-47.4% to ?7.6%] versus ?20.0% [-40.0% to 0.0%], P=0.4). Results did not differ between patients with drug-eluting stents (n=46) and patients with bare-metal stents (n=24). Conclusions: This study demonstrates that in patients with coronary arteries in which a stent has been placed, coronary microcirculatory and epicardial vascular function are not significantly different from that of an age- and sex-matched population with similar symptoms but nonsignificant coronary artery disease.

KW - Coronary disease

KW - Endothelium

KW - Microcirculation

KW - Stents

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