Avaliação da função endotelial coronária de pacientes submetidos ao implante de stents de cromo-cobalto convencional ou eluidores de sirolimus com polímero biodegradável ao final de nove meses
Data
2024-02-19
Autores
Souza, Rodrigo Almeida 
Orientadores
Barbosa, Adriano Henrique Pereira
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Stents farmacológicos têm sido relacionados à alteração da vasomotricidade coronária e reendotelização tardia, aumentando o risco de trombose. Contudo, a controvérsia persiste sobre se esses efeitos estão ligados ao tipo de polímero, droga ou ao próprio stent. Objetivo: Avaliar a vasomotricidade coronária após o implante de stent de cromo-cobalto convencional (Cronus NE®) em comparação com stent de cromo-cobalto eluidor de sirolimus (Inspiron®). Métodos: Estudo prospectivo, unicêntrico, aberto e randomizado realizado na Universidade Federal de São Paulo entre abril de 2014 e outubro de 2017. Trinta pacientes elegíveis para intervenção coronária percutânea foram randomizados para receber implante de Inspiron ou Cronus NE. A função endotelial foi avaliada pela vasorreatividade coronária após infusão de acetilcolina 4h após o procedimento índice e aos nove meses de seguimento. Análise Coronária Quantitativa foi conduzida offline por um centro independente cego ao tipo de stent utilizado. Resultados: Vinte indivíduos (10 Inspiron x 10 Cronus NE.) foram incluídos na análise final, com características basais semelhantes. Após a infusão máxima de acetilcolina, não houve diferença estatisticamente significante na variação percentual dos diâmetros da borda proximal (p = 0,221), do segmento do stent (p = 0,326) e borda distal (p = 0,725) entre os grupos Inspiron e 10 Cronus. Conclusão: Em comparação com sua contraparte convencional, o stent de cromo-cobalto eluidor de sirolimus com polímero biodegradável (Inspiron®) não demonstrou associação com piora da função vasomotora ao longo do estudo.
Introduction: Drugeluting stents have been associated with impairment in coronary vasomotility and late reendothelialization, increasing the risk of late stent thrombosis. However, controversy persists regarding whether these effects are linked to the type of polymer, drug, or the stent itself. Objective: To evaluate coronary vasomotility after implantation of a conventional cobaltchromium stent (Cronus NE®) compared to a sirolimuseluting cobaltchromium stent (Inspiron®). Methods: A prospective, singlecenter, openlabel, randomized study was conducted at the Federal University of São Paulo between April 2014 and October 2017. Thirty patients eligible for percutaneous coronary intervention were randomized to receive Inspiron® or Cronus NE® implantation. Endothelial function was assessed by coronary vasoreactivity after acetylcholine infusion at 4 hours postindex procedure and nine months of followup. Quantitative Coronary Analysis was conducted offline by an independent center blinded to the type of stent used. Results: Twenty individuals (10 Inspiron® x 10 Cronus NE®) were included in the final analysis, with similar baseline characteristics. After maximal acetylcholine infusion, there was no statistically significant difference in the percentage change in diameters of proximal border (p = 0.221), stented segment (p = 0.326), and distal border (p = 0.725) between Inspiron® and Cronus NE® groups. Conclusion: In comparison with its conventional counterpart, the sirolimuseluting cobaltchromium stent with a biodegradable polymer (Inspiron®) did not demonstrate an association with vasomotor dysfunction throughout the study.
Introduction: Drugeluting stents have been associated with impairment in coronary vasomotility and late reendothelialization, increasing the risk of late stent thrombosis. However, controversy persists regarding whether these effects are linked to the type of polymer, drug, or the stent itself. Objective: To evaluate coronary vasomotility after implantation of a conventional cobaltchromium stent (Cronus NE®) compared to a sirolimuseluting cobaltchromium stent (Inspiron®). Methods: A prospective, singlecenter, openlabel, randomized study was conducted at the Federal University of São Paulo between April 2014 and October 2017. Thirty patients eligible for percutaneous coronary intervention were randomized to receive Inspiron® or Cronus NE® implantation. Endothelial function was assessed by coronary vasoreactivity after acetylcholine infusion at 4 hours postindex procedure and nine months of followup. Quantitative Coronary Analysis was conducted offline by an independent center blinded to the type of stent used. Results: Twenty individuals (10 Inspiron® x 10 Cronus NE®) were included in the final analysis, with similar baseline characteristics. After maximal acetylcholine infusion, there was no statistically significant difference in the percentage change in diameters of proximal border (p = 0.221), stented segment (p = 0.326), and distal border (p = 0.725) between Inspiron® and Cronus NE® groups. Conclusion: In comparison with its conventional counterpart, the sirolimuseluting cobaltchromium stent with a biodegradable polymer (Inspiron®) did not demonstrate an association with vasomotor dysfunction throughout the study.
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Citação
SOUZA, Rodrigo Almeida. Avaliação da função endotelial coronária de pacientes submetidos ao implante de stents de cromo-cobalto convencional ou eluidores de sirolimus com polímero biodegradável ao final de nove meses. 2024. 115 f. Tese (Doutorado em Cardiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024