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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Effect of coronary endothelial function on outcomes in patients undergoing percutaneous coronary intervention
1Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Japan. hamasksh@m.kufm.kagoshima-u.ac.jp
Insights
Drug-eluting stents may cause endothelial dysfunction, increasing risks compared to bare-metal stents. Medical treatments alongside percutaneous coronary intervention offer a potential strategy to mitigate cardiovascular events.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Endothelial dysfunction is linked to adverse cardiovascular events, including coronary artery disease.
- Coronary artery disease involves arterial changes leading to ischemia or plaque rupture, often associated with endothelial dysfunction.
- Drug-eluting stents (DES) may induce coronary artery endothelial dysfunction, potentially leading to late stent thrombosis.
Purpose of the Study:
- To review the association between endothelial dysfunction and cardiovascular events.
- To evaluate the impact of drug-eluting stents (DES) versus bare-metal stents (BMS) on endothelial function.
- To explore medical treatments that improve endothelial function in patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- Literature review of studies on endothelial dysfunction and cardiovascular outcomes.
- Comparative analysis of DES and BMS regarding endothelial function and stent thrombosis.
- Examination of pharmacological interventions for endothelial dysfunction.
Main Results:
- DES implantation may induce coronary artery endothelial dysfunction compared to BMS.
- Despite reduced restenosis, DES and BMS show similar rates of death and myocardial infarction.
- Medical therapies like statins, ACE inhibitors, and ARBs can improve endothelial dysfunction.
Conclusions:
- Endothelial dysfunction is a critical factor in cardiovascular events and stent-related complications.
- While DES reduce restenosis, their impact on endothelial function and late thrombosis warrants consideration.
- Combining PCI with medical treatments that improve endothelial function may stabilize plaque and prevent new lesions.
Abstract:
Numerous studies have documented the association between endothelial dysfunction and adverse cardiovascular events. For example, coronary artery disease is associated with functional and structural changes of the coronary arteries, resulting in ischemia or plaque rupture, and is highly associated with endothelial dysfunction. Recent data suggest that implantation of drug-eluting stents (DES) can induce coronary artery endothelial dysfunction at follow-up when compared with bare-metal stents (BMS) and that this endothelial dysfunction may be associated with late stent thrombosis. Indeed, despite the superiority of DES in preventing restenosis, the incidence of death and myocardial infarction is similar when comparing DES with BMS. Medical treatment, such as statins, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers, can improve endothelial dysfunction. Thus, administration of these drugs along with percutaneous coronary intervention (PCI) may be a low-risk strategy to provide therapeutic benefit by stabilizing unstable plaque or by suppressing new lesion formation in patients undergoing PCI.
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