(J Interven Cardiol 2010;23:195-202)

BackgroundThe impact of acute stent malapposition (ASM) on long‐term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long‐term clinical outcomes of ASM.Methods and Results ADAPT‐DES (Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug‐eluting stents. In a prespecified intravascular ultrasound–guided substudy, 2072 patients with 2446 culprit lesions had post–percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound–guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug‐eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in‐stent lumen areas, larger stent areas, and larger in‐stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2‐year follow‐up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2‐year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model.ConclusionsIn patients treated with intravascular ultrasound–guided drug‐eluting stents implantation, ASM was not associated with adverse clinical events during long‐term follow‐up including, but not limited to, stent thrombosis.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.

RESUMOAs células-tronco mesenquimais representam uma rara subpopulação das células-tronco da medula óssea (< 0,01% das células mononucleares da medula óssea) com capacidade de expansão mitótica in vitro. Em decorrência da facilidade em se dividir e proliferar, concluiu-se que as células-tronco mesenquimais seriam as células responsáveis pela manutenção e renovação dos tecidos mesenquimais adultos, incluindo o músculo cardíaco. Esse tipo celular apresenta como uma de suas virtudes considerável atividade imunossupressora, evitando assim efeitos adversos relacionados a rejeição entre o material infundido e o hospedeiro. As células-tronco mesenquimais vêm sendo cada vez mais estudadas, tanto em ensaios pré-clínicos como clínicos. Acreditamos que, superados alguns desafios em seu isolamento, preparo e modo de infusão, essas células poderão, em futuro próximo, representar o tipo celular ideal para a regeneração cardíaca.DESCRITORES: Células tronco. Células tronco mesenquimais. Terapêutica. Miocárdio. ABSTRACT Mesenchymal Stem Cells: Are They Appropriate for Cardiac Regeneration?Mesenchymal stem cells represent a rare subpopulation of bone marrow stem cells (< 0.01% of mononuclear cells originated from bone marrow) with capacity for in vitro mitotic expansion. Because they split and proliferate easily, mesenchymal stem cells are believed to be responsible for the maintenance and renovation of adult mesenchymal tissues, including the cardiac muscle. One of the virtues of this type of cell is their immunosuppressive activity, avoiding therefore the adverse events related to graft rejection by the host (graft versus host disease). Mesenchymal stem cells have been extensively studied, both in preclinical and clinical trials. We believe that once some challenges regarding their isolation, preparation and mode of delivery are overcome, these cells may, in the near future, represent the ideal cell type for cardiac regeneration. KEY-WORDS: Stem cells. Mesenchymal stem cells. Therapeutics. Myocardium.A s células-tronco são células indiferenciadas, caracterizadas pela capacidade de autorrenovação, diferenciação em diversos tipos celulares e reconstituição funcional de determinados tecidos. Didaticamente, são divididas em dois tipos principais: embrionárias e adultas.As células-tronco embrionárias para terapia podem ser derivadas da massa interna do blastocisto ou do zigoto. As primeiras possuem capacidade ilimitada de autorrenovação e são pluripotentes (capazes de se diferenciar em qualquer linhagem derivada dos três folhetos embrionários: endoderma, mesoderma e ectoderma). Já as células com origem a partir do zigoto são classificadas como totipotentes, pois, além de se diferenciar nas células dos três folhetos embrionários, originam os tecidos extraembrionários. Em contraste, as células-tronco adultas aparentemente têm capacidade de autorrenovação limitada e são denominadas multipotentes, pela capacidade limitada de diferenciação em poucos tipos celulares.As células estromais da medula óssea foram primeiramente descritas como c...

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Objective:To evaluate the incidence of major adverse cardiac events (cardiac death, or acute myocardial infarct, or target vessel revascularization) at one year in “real world” patients.Methods:The EINSTEIN registry is an observational, prospective, single center study that consecutively included 103 patients (152 lesions) treated with the Biomatrix™ stent, a biolimus A9-eluting stent with biodegradable polymer.Results:The mean age was 65.0±12.4 years; male gender represented 83.5% of the patients; and 37.9% of them were diabetic. At one-year, major adverse cardiac events occurred in 11.7% of the patients, including 2.9% of cardiac death, 4.9% of with non ST- segment elevation acute myocardial infarction, and 3.9% of target vessel revascularization. Stent thrombosis occurred in only 1% (1 patient) at one-yearfollow-up.Conclusion:The present Registry suggests that new generation biolimus A9 drug-eluting stents are safe and effective in a “real world”, all-comers patients, showing low rates of major cardiac adverse events on long-term follow-up.