RESUMEN
AIM: Percutaneous coronary intervention (PCI) is the gold standard for the treatment of acute myocardial infarction (AMI), with the main limitation of in-stent restenosis for BMS and late stent thrombosis (ST) for both BMS and DES. Endothelial progenitor cells (EPC) CD34+ capture stents, promoting vascular healing, may be advantageous in preventing ST. Aim of the study is to evaluate the outcomes of AMI patients treated with EPC CD34+ capture stent and describe the mobilization kinetics of CD34+ and their clinical correlation. METHODS: Fifty AMI patients underwent primary PCI with EPC CD34+ capture stent. Serial assays of CD34+ were performed by flow-cytometric analysis. RESULTS: Procedural success rate was 100%. At six-months follow-up cardiac death, myocardial infarction, target lesion revascularization (TLR) and target vessel revascularization (TVR) occurred respectively in 2%, 4%, 10% and 12% of patients. No case of ST was observed. The MACE-free survival was 81,2%. The mean peak value of plasmatic CD34+ was 4.69±3.76 cells/µL. A positive correlation was found between CD34+ concentration, age and infarct area. No correlation was detected between CD34+ concentration and occurrence of TVR, TLR and MACE. CONCLUSION: EPC capture stent implantation seems to be safe and effective in the clinical setting of AMI, representing a possible alternative to BMS and DES. CD34+ cells plasmatic concentration seems not to correlate to coronary restenosis and atheromasic disease progression.
Asunto(s)
Movilización de Célula Madre Hematopoyética , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/instrumentación , Stents , Anciano , Antígenos CD34/análisis , Recuento de Células Sanguíneas , Comorbilidad , Reestenosis Coronaria/epidemiología , Reestenosis Coronaria/prevención & control , Reestenosis Coronaria/cirugía , Trombosis Coronaria/epidemiología , Trombosis Coronaria/prevención & control , Supervivencia sin Enfermedad , Endotelio Vascular/fisiología , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/cirugía , Intervención Coronaria Percutánea/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Regeneración , Sistema de Registros , Factores de Riesgo , Stents/efectos adversos , Resultado del TratamientoRESUMEN
AIM: Drug eluting stents (DES) are currently the gold standard for the treatment of significant coronary artery stenosis in high risk patients. In case of undeferrable non-cardiac surgery their use is still a challenge, due to the need of a prolonged dual antiplatelet therapy. We aimed to prospectively evaluate the efficacy and safety of the implantation of endothelial progenitor cells (EPC) capture stent followed by a short dual anti-platelet therapy (DAT) period in a high risk population of patients undergoing undeferrable non-cardiac surgery. METHODS: We examined all consecutive patients who received EPCs capture stents and underwent non-cardiac surgery within 60 days of percutaneous coronary intervention. Our primary outcome was the occurrences of cardiac death, myocardial infarction (MI), stent thrombosis (ST), target vessel revascularization (TVR) and major adverse cardiac events (MACE). RESULTS: Twenty-six patients underwent PCI and were enrolled, but only 20 underwent surgical intervention. Technical and procedural success rates were both 100%. No perioperative MACE was detected. After a mean long term follow-up of 15.4±10.3 months, 2 cases of cardiac death (10%), were recorded. No case of stent thrombosis was reported; no case of ischemia driven TLR was detected. The total MACE-free survival probability was 66.5%. CONCLUSION: EPC capture stent implantation in high-risk patients requiring undeferrable non-cardiac surgery seems to allow early cand safe discontinuation of DAT, and may be an attractive alternative to conventional stents.