Yonsei Med J.  2015 Jan;56(1):45-52. 10.3349/ymj.2015.56.1.45.

Impact of Statin Treatment on Strut Coverage after Drug-Eluting Stent Implantation

Affiliations
  • 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. mkhong61@ yuhs.ac
  • 2Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
To evaluate the effect of statin treatment on strut coverage after drug-eluting stent (DES) implantation.
MATERIALS AND METHODS
In this study, 60 patients were randomly assigned to undergo sirolimus-eluting stent (SES) or biolimus-eluting stent (BES) implantation, after which patients were randomly treated with pitavastatin 2 mg or pravastatin 20 mg for 6 months. The degree of strut coverage was assessed by 6-month follow-up optical coherence tomography, which was performed in 52 DES-implanted patients.
RESULTS
The percentages of uncovered struts were 19.4+/-14.7% in pitavastatin-treated patients (n=25) and 19.1+/-15.2% in pravastatin-treated patients (n=27; p=0.927). A lower percentage of uncovered struts was significantly correlated with a lower follow-up low-density lipoprotein (LDL) cholesterol level (r=0.486; p=0.009) and a greater decline of the LDL cholesterol level (r=-0.456; p=0.015) in SES-implanted patients, but not in BES-implanted patients. In SES-implanted patients, the percentage of uncovered struts was significantly lower among those with LDL cholesterol levels of less than 70 mg/dL after 6 months of follow-up (p=0.025), but no significant difference in this variable according to the follow-up LDL cholesterol level was noted among BES-implanted patients (p=0.971).
CONCLUSION
Lower follow-up LDL cholesterol levels, especially those less than 70 mg/dL, might have a protective effect against delayed strut coverage after DES implantation. This vascular healing effect of lower LDL cholesterol levels could differ according to the DES type.

Keyword

Stent; optical coherence tomography; statin

MeSH Terms

Adult
Coronary Angiography
*Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
Lipoproteins, LDL/blood
Male
Middle Aged
Pravastatin/therapeutic use
*Prosthesis Implantation
Quinolines/therapeutic use
Tomography, Optical Coherence
Treatment Outcome
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Lipoproteins, LDL
Quinolines
Pravastatin

Figure

  • Fig. 1 A flowchart of the study is shown.

  • Fig. 2 The relationships of the percentage of uncovered struts with follow-up low-density lipoprotein (LDL) cholesterol levels are presented. Black and red dots represent biolimus-eluting stents and sirolimus-eluting stents, respectively.

  • Fig. 3 The relationships of the percentage of uncovered struts with the degree of low-density lipoprotein (LDL) cholesterol level reduction are presented. Black and red dots represent biolimus-eluting stents and sirolimus-eluting stents, respectively.


Cited by  2 articles

Early Effects of Intensive Lipid-Lowering Treatment on Plaque Characteristics Assessed by Virtual Histology Intravascular Ultrasound
Jung-Hee Lee, Dong-Ho Shin, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong-Ki Hong
Yonsei Med J. 2016;57(5):1087-1094.    doi: 10.3349/ymj.2016.57.5.1087.

Concomitant Statin Use Has a Favorable Effect on Gemcitabine-Erlotinib Combination Chemotherapy for Advanced Pancreatic Cancer
Do Chang Moon, Hee Seung Lee, Yong Il Lee, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, Si Young Song, Jae Bock Chung, Seungmin Bang
Yonsei Med J. 2016;57(5):1124-1130.    doi: 10.3349/ymj.2016.57.5.1124.


Reference

1. Farb A, Burke AP, Kolodgie FD, Virmani R. Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation. 2003; 108:1701–1706.
Article
2. Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, et al. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation. 2007; 115:2435–2441.
Article
3. Guagliumi G, Sirbu V, Musumeci G, Gerber R, Biondi-Zoccai G, Ikejima H, et al. Examination of the in vivo mechanisms of late drug-eluting stent thrombosis: findings from optical coherence tomography and intravascular ultrasound imaging. JACC Cardiovasc Interv. 2012; 5:12–20.
Article
4. Won H, Shin DH, Kim BK, Mintz GS, Kim JS, Ko YG, et al. Optical coherence tomography derived cut-off value of uncovered stent struts to predict adverse clinical outcomes after drug-eluting stent implantation. Int J Cardiovasc Imaging. 2013; 29:1255–1263.
Article
5. Prati F, Regar E, Mintz GS, Arbustini E, Di Mario C, Jang IK, et al. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J. 2010; 31:401–415.
Article
6. Lee SY, Hong MK. Stent evaluation with optical coherence tomography. Yonsei Med J. 2013; 54:1075–1083.
Article
7. Kim JS, Jang IK, Kim JS, Kim TH, Takano M, Kume T, et al. Optical coherence tomography evaluation of zotarolimus-eluting stents at 9-month follow-up: comparison with sirolimus-eluting stents. Heart. 2009; 95:1907–1912.
Article
8. Takano M, Inami S, Jang IK, Yamamoto M, Murakami D, Seimiya K, et al. Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol. 2007; 99:1033–1038.
Article
9. Kim JS, Fan C, Choi D, Jang IK, Lee JM, Kim TH, et al. Different patterns of neointimal coverage between acute coronary syndrome and stable angina after various types of drug-eluting stents implantation; 9-month follow-up optical coherence tomography study. Int J Cardiol. 2011; 146:341–346.
Article
10. Kubo T, Imanishi T, Kitabata H, Kuroi A, Ueno S, Yamano T, et al. Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris: a serial optical coherence tomography study. JACC Cardiovasc Imaging. 2008; 1:475–484.
Article
11. Mihos CG, Salas MJ, Santana O. The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in cardiovascular disease: a comprehensive review. Cardiol Rev. 2010; 18:298–304.
Article
12. Indolfi C, Cioppa A, Stabile E, Di Lorenzo E, Esposito G, Pisani A, et al. Effects of hydroxymethylglutaryl coenzyme A reductase inhibitor simvastatin on smooth muscle cell proliferation in vitro and neointimal formation in vivo after vascular injury. J Am Coll Cardiol. 2000; 35:214–221.
Article
13. Bellosta S, Bernini F, Ferri N, Quarato P, Canavesi M, Arnaboldi L, et al. Direct vascular effects of HMG-CoA reductase inhibitors. Atherosclerosis. 1998; 137:Suppl. S101–S109.
Article
14. Wang TJ, Yang YJ, Xu B, Zhang Q, Jin C, Tang Y, et al. Atorvastatin accelerates both neointimal coverage and re-endothelialization after sirolimus-eluting stent implantation in a porcine model: new findings from optical coherence tomography and pathology. Circ J. 2012; 76:2561–2571.
15. Jaschke B, Michaelis C, Milz S, Vogeser M, Mund T, Hengst L, et al. Local statin therapy differentially interferes with smooth muscle and endothelial cell proliferation and reduces neointima on a drug-eluting stent platform. Cardiovasc Res. 2005; 68:483–492.
Article
16. Kim BK, Ha J, Mintz GS, Kim JS, Shin DH, Ko YG, et al. Randomised comparison of strut coverage between Nobori biolimus-eluting and sirolimus-eluting stents: an optical coherence tomography analysis. EuroIntervention. 2014; 9:1389–1397.
Article
17. Tanigawa J, Barlis P, Dimopoulos K, Dalby M, Moore P, Di Mario C. The influence of strut thickness and cell design on immediate apposition of drug-eluting stents assessed by optical coherence tomography. Int J Cardiol. 2009; 134:180–188.
Article
18. Davlouros PA, Mavronasiou E, Xanthopoulou I, Karantalis V, Tsigkas G, Hahalis G, et al. An optical coherence tomography study of two new generation stents with biodegradable polymer carrier, eluting paclitaxel vs. biolimus-A9. Int J Cardiol. 2012; 157:341–346.
Article
19. Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, et al. Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol. 2006; 97:1713–1717.
Article
20. Doran H, Bates D, Bliese P, Dowling M. Estimating the multilevel Rasch model: with the lme4 package. J Stat Softw. 2007; 20:1–18.
21. Kim BK, Kim JS, Oh C, Ko YG, Choi D, Jang Y, et al. Major determinants for the uncovered stent struts on optical coherence tomography after drug-eluting stent implantation. Int J Cardiovasc Imaging. 2012; 28:705–714.
Article
22. Kim BK, Kim JS, Oh C, Ko YG, Choi D, Jang Y, et al. Impact of preprocedural high-sensitivity C-reactive protein levels on uncovered stent struts: an optical coherence tomography study after drug-eluting stent implantation. Clin Cardiol. 2011; 34:97–101.
Article
23. Ishigami K, Uemura S, Morikawa Y, Soeda T, Okayama S, Nishida T, et al. Long-term follow-up of neointimal coverage of sirolimus-eluting stents--evaluation with optical coherence tomography. Circ J. 2009; 73:2300–2307.
Article
24. Fukuda D, Enomoto S, Shirakawa I, Nagai R, Sata M. Fluvastatin accelerates re-endothelialization impaired by local sirolimus treatment. Eur J Pharmacol. 2009; 612:87–92.
Article
25. Wolfrum S, Jensen KS, Liao JK. Endothelium-dependent effects of statins. Arterioscler Thromb Vasc Biol. 2003; 23:729–736.
Article
26. Werner N, Priller J, Laufs U, Endres M, Böhm M, Dirnagl U, et al. Bone marrow-derived progenitor cells modulate vascular reendothelialization and neointimal formation: effect of 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition. Arterioscler Thromb Vasc Biol. 2002; 22:1567–1572.
Article
27. Walter DH, Zeiher AM, Dimmeler S. Effects of statins on endothelium and their contribution to neovascularization by mobilization of endothelial progenitor cells. Coron Artery Dis. 2004; 15:235–242.
Article
28. Sakamoto T, Kojima S, Ogawa H, Shimomura H, Kimura K, Ogata Y, et al. Usefulness of hydrophilic vs lipophilic statins after acute myocardial infarction: subanalysis of MUSASHI-AMI. Circ J. 2007; 71:1348–1353.
Article
29. Satoh K, Ichihara K. Lipophilic HMG-CoA reductase inhibitors increase myocardial stunning in dogs. J Cardiovasc Pharmacol. 2000; 35:256–262.
Article
30. Saku K, Zhang B, Noda K. PATROL Trial Investigators. Randomized head-to-head comparison of pitavastatin, atorvastatin, and rosuvastatin for safety and efficacy (quantity and quality of LDL): the PATROL trial. Circ J. 2011; 75:1493–1505.
Article
31. Hayashi T, Yokote K, Saito Y, Iguchi A. Pitavastatin: efficacy and safety in intensive lipid lowering. Expert Opin Pharmacother. 2007; 8:2315–2327.
Article
32. Chevalier B, Silber S, Park SJ, Garcia E, Schuler G, Suryapranata H, et al. Randomized comparison of the Nobori Biolimus A9-eluting coronary stent with the Taxus Liberté paclitaxel-eluting coronary stent in patients with stenosis in native coronary arteries: the NOBORI 1 trial--Phase 2. Circ Cardiovasc Interv. 2009; 2:188–195.
Article
33. Ostojic M, Sagic D, Beleslin B, Jung R, Perisic Z, Jagic N, et al. First clinical comparison of Nobori -Biolimus A9 eluting stents with Cypher- Sirolimus eluting stents: Nobori Core nine months angiographic and one year clinical outcomes. EuroIntervention. 2008; 3:574–579.
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr