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Sirolimus as primary immunosuppression is associated with improved coronary vasomotor function compared with calcineurin inhibitors in stable cardiac transplant recipients
European Heart Journal, 04/23/09

Raichlin E et al. – Sirolimus immunosuppression is associated with less pronounced coronary epicardial endothelial dysfunction compared with cyclosporin (CyA) immunosuppression. Improvement of coronary vasomotor function with sirolimus (SRL) may be an important mechanism for the prevention of cardiac allograft vasculopathy (CAV).

Methods

Study of coronary vasomotor function in cardiac transplant recipients maintained on SRL- or CyA-based immunosuppression
Assessment of endothelium-independent response to intracoronary nitroglycerin and adenosine and endothelium-dependent response to intracoronary acetylcholine (Ach)
Evaluation of 15 SRL- and 21 CyA- treated pts with angiographically normal coronary arteries

Results

Baseline mean blood pressure lower in SRL (85.6 ± 10.3 mmHg) vs CyA pts (105.2 ± 8.7 mmHg)
No difference between groups in coronary flow reserve after adenosine administration on multivariable analysis
Nitroglycerin resulted in increase in coronary artery diameter in SRL (2.79 ± 0.54) vs CyA pts (2.57 ± 0.61)
Ach administration resulted in less epicardial vasoconstriction for 13 SRL pts without evidence of CAV (2.7 ± 17.7%) vs CyA pts (–15.6 ± 17.2%)
Coronary spasm in response to Ach 10–4 for 2 SRL pts with 3D intravascular ultrasound evidence of CAV
Microvascular endothelial function did not differ between the groups

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