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Myocardial Blood Flow and Coronary Flow Reserve During 3 Years Following Bioresorbable Vascular Scaffold Versus Metallic Drug-Eluting Stent Implantation

冠状动脉血流储备 医学 部分流量储备 心脏病学 正电子发射断层摄影术 依维莫司 内科学 临床终点 支架 血流 药物洗脱支架 反应性充血 冠状动脉 冠状动脉疾病 心肌灌注成像 灌注 再狭窄 心肌梗塞 核医学 随机对照试验 动脉 冠状动脉造影
作者
Wijnand J. Stuijfzand,Stefan Schumacher,Roel Driessen,Adriaan A. Lammertsma,Amber L. Bakker,Mischa T. Rijnierse,Albert C. van Rossum,Peter M. van de Ven,Alexander Nap,Yolande Appelman,Niels van Royen,Maarten A. van Leeuwen,Jorrit S. Lemkes,Pieter Raijmakers,Paul Knaapen
出处
期刊:Jacc-cardiovascular Interventions [Elsevier BV]
卷期号:12 (10): 967-979 被引量:7
标识
DOI:10.1016/j.jcin.2019.03.004
摘要

The randomized clinical VANISH (Impact of Vascular Reparative Therapy on Vasomotor Function and Myocardial Perfusion: A Randomized [15O]H2O PET/CT Study) trial was conducted to assess quantitative myocardial blood flow (MBF) during resting, hyperemia, and cold pressor testing (CPT) with positron emission tomographic perfusion imaging after the implantation of a bioresorbable everolimus-eluting scaffold compared with a drug-eluting stent.Long-term resorption of the bioresorbable everolimus-eluting scaffold reinstates normal vessel geometry, allowing natural regeneration of the newly formed endothelium with revival of vasomotor function.Sixty patients (18 to 65 years of age) with single-vessel disease and type A or B1 lesions were randomized in a 1-to-1 fashion. Approximately 1 month, 1 year, and 3 years after device implantation, patients underwent [15O]H2O cardiac positron emission tomography. The primary endpoint was the interaction of device type and evolution over time of hyperemic MBF, coronary flow reserve, or CPT reserve. At 3-year follow-up, control invasive coronary angiography with optical coherence tomography was performed.Fifty-nine (98%), 56 (93%), and 51 (85%) patients successfully completed 1-month, 1-year, and 3-year follow-up positron emission tomography, respectively, and no culprit vessel events were registered during follow-up time. The primary study endpoint (i.e., interaction between device type and time) was nonsignificant for hyperemic MBF, CPT reserve, and coronary flow reserve (p > 0.05 for all). In all patients, hyperemic MBF decreased from 1 to 3 years (p = 0.02), while coronary flow reserve was lower at 3-year follow-up compared with 1-month and 1-year follow-up (p = 0.03 for both). After 3 years, percentage area stenosis measured with optical coherence tomography was higher within the bioresorbable everolimus-eluting scaffold compared with the drug-eluting stent (p = 0.03).The hypothesized beneficial effects of scaffold resorption did not translate to improved MBF during maximal hyperemia or endothelium-dependent vasodilation by CPT.
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