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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Drug-eluting stents may not reduce target lesion revascularization in cardiac allograft vasculopathy
Ki E Park1, Tianyao Huo, Keith E Muller
1Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida.
Insights
Drug-eluting stents (DES) showed less in-stent restenosis (ISR) than bare metal stents (BMS) in cardiac allograft vasculopathy (CAV). However, this did not improve clinical outcomes, suggesting BMS may be sufficient for CAV treatment.
Area of Science:
- Cardiology
- Transplantation Immunology
- Interventional Cardiology
Background:
- Cardiac allograft vasculopathy (CAV) is a primary cause of death after heart transplantation.
- Limited treatment options exist for CAV, yet drug-eluting stent (DES) use is increasing.
- The comparative efficacy of DES versus bare metal stents (BMS) in CAV is not well-established.
Purpose of the Study:
- To compare the efficacy of DES versus BMS in treating CAV.
- To evaluate rates of in-stent restenosis (ISR) and target lesion revascularization (TLR) between stent types.
- To assess the impact of stent choice on major adverse cardiovascular events in heart transplant recipients with CAV.
Main Methods:
- Retrospective analysis of 45 heart transplant patients who underwent percutaneous coronary intervention for CAV.
- Comparison of baseline characteristics, clinical outcomes, ISR, and TLR between BMS and DES groups.
- Primary endpoint: angiographic ISR assessed quantitatively (continuous and binary variables). Secondary endpoints: TLR and a composite of adverse cardiovascular events.
Main Results:
- ISR was significantly lower with DES compared to BMS when analyzed as a continuous variable (0.796 vs. 0.481, P=0.0037).
- ISR was also significantly lower with DES versus BMS when assessed as a binary variable (10.8% vs. 30.7%).
- No significant differences were observed in TLR or composite cardiovascular outcomes between the groups after adjusting for risk factors.
Conclusions:
- While DES demonstrated a significant reduction in ISR compared to BMS in CAV patients, this did not translate to improved clinical outcomes.
- These findings suggest that BMS may be a viable and potentially less costly alternative to DES for treating CAV.
- Further hypothesis-generating research is needed to confirm these observations and guide optimal stent selection in this patient population.
Objective:
Although drug-eluting stent (DES) compared with bare metal stent (BMS) use reduces in-stent restenosis (ISR) in traditional coronary artery disease, its efficacy in cardiac allograft vasculopathy (CAV) has not been clearly established.
Background:
CAV is a leading cause of mortality after the first year following cardiac transplantation. CAV treatment options are limited, and DES use has increased significantly in this population.
Methods:
In a retrospective study of heart transplant patients at our institution who underwent percutaneous coronary intervention with a BMS or DES for CAV, we compared baseline characteristics, clinical outcomes, ISR, and target lesion revascularization (TLR). The primary end-point was angiographic ISR assessed by quantitative coronary angiography analyzed as both a binary (≤50% vs. >50%) and continuous variable (follow-up minimal luminal area [MLA]/baseline MLA). Secondary outcomes included TLR and a composite of death, myocardial infarction, heart failure, and retransplantation.
Results:
In 45 patients with DES, BMS, or both, ISR assessed as a continuous variable was statistically different between the 2 stent groups (follow-up MLA/baseline MLA = 0.796 DES vs. 0.481 BMS; P = 0.0037). There was also a significant difference in ISR (10.8% for DES versus 30.7% for BMS) when assessed as a binary variable. There was no statistically significant difference in TLR or composite cardiovascular outcomes between groups when adjusted for traditional cardiovascular risk factors.
Conclusions:
ISR assessed as a continuous variable was significantly different between stent groups. However, this did not lead to a difference in TLR or cardiovascular outcomes. This hypothesis-generating finding suggests that patients with CAV may not necessarily need treatment with DES, which can be more costly and carries more potential risk than BMS.
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