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Impact of Stent Type and Presence of Vasospastic Angina on Long-Term Prognosis

Reo Hata1, Naoki Oka1, Shunsuke Kubo1

  • 1Department of Cardiology, Kurashiki Central Hospital.

Circulation Journal : Official Journal of the Japanese Circulation Society
|June 30, 2017
PubMed

Insights

The type of stent used in vasospastic angina (VSA) impacts patient outcomes. Sirolimus-eluting stents (SES) showed worse results in VSA patients compared to non-VSA patients, unlike newer drug-eluting stents (N-DES) or bare-metal stents (BMS).

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Vasospastic angina (VSA) significantly impacts patient prognosis after stent implantation, but the influence of stent type remains unclear.
  • Understanding stent performance in VSA is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To investigate the impact of different stent types on clinical and angiographic outcomes in patients with and without vasospastic angina (VSA).

Main Methods:

  • A comparative study evaluated 304 patients undergoing stent implantation, categorized by VSA status (positive or negative ergonovine testing) and stent type (bare-metal stent [BMS], sirolimus-eluting stent [SES], or newer generation drug-eluting stent [N-DES]).
  • Primary outcomes included target lesion revascularization, target vessel revascularization, emergency coronary angiography, and cardiac death over 2 years.
  • Angiographic follow-up assessed percent diameter stenosis.

Main Results:

  • Sirolimus-eluting stents (SES) showed a significantly higher 2-year incidence of adverse outcomes in VSA patients compared to non-VSA patients (38.1% vs. 16.1%, P=0.03).
  • VSA patients receiving SES also exhibited greater percent diameter stenosis at follow-up (10.0% vs. 2.3%, P=0.045).
  • No significant differences in outcomes or stenosis were observed between VSA and non-VSA groups following implantation of bare-metal stents (BMS) or newer generation drug-eluting stents (N-DES).

Conclusions:

  • The adverse impact of vasospastic angina (VSA) on clinical and angiographic outcomes is specific to sirolimus-eluting stent (SES) implantation.
  • Bare-metal stents (BMS) and newer generation drug-eluting stents (N-DES) appear to mitigate the negative effects of VSA, suggesting improved stent selection for these patients.
Abstract

Keywords:
Coronary stenosisDrug-eluting stentLong-term prognosisVasospastic angina

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