eptifibatide therapy is associated with improved CFR after stent placement. In addition to improvements in CFR, tissue level perfusion (as assessed with digital subtraction angiog- raphy) also tended to be improved. Although the rates of TIMI myocardial perfusion grade 3 were similar between the 2 treatment arms, it is notable that there tended to be more patients with a right coronary artery culprit lesion in the placebo arm. We have previously demonstrated that right coronary artery lesions tend to have a higher rate of TIMI myocardial perfusion grade 3, 5 and this may explain in part the similar rates of TIMI myocardial perfusion grade 3 observed. How- ever, when the more quantitative and sensitive tech- nique of digital subtraction angiography was applied, and when potential imbalances in culprit artery loca- tion were corrected for, myocardial blush tended to be larger and brighter and it grew in size and brightness more rapidly among patients treated with eptifibatide. It is notable that the measures of tissue level perfu- sion, such as the digital subtraction angiography re- serve, were highly correlated with epicardial CFR (r = 0.76, p 0.001). Taken together, these findings suggest that eptifibatide therapy is associated with improved microvascular function and myocardial per- fusion after elective stenting. This improvement in microvascular function may explain in part the supe- rior clinical outcomes that have been observed in many trials of glycoprotein IIb/IIIa inhibition in the setting of percutaneous coronary intervention. Indeed, we have previously demonstrated that in the acute myocardial infarction setting, not all TIMI grade 3 flow is created equally: the achievement of TIMI grade 3 flow with a persistently closed microvascula- ture is associated with a 5.4% mortality, whereas there is 7-fold reduction in mortality to 0.7% if the mi- crovasculature is also open. 5 Eptifibatide administration was associated with improved CFR after stent placement and a greater rate of increase in the brightness of myocardial blush after adenosine administration using digital subtraction angiography. These findings suggest eptifibatide therapy is associated with improved microvascular perfusion after coronary stent im- plantation, although these findings require further prospective validation. 1. The ESPRIT Investigators. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. Lancet 2000; 356:2037–2044. 2. Gibson CM, Cannon CP, Daley WL, Dodge JT, Alexander B, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. The TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93:879 – 888. 3. Gibson CM, Murphy SA, Rizzo MJ, Ryan KA, Marble SJ, McCabe CH, Cannon CP, Van de Werf F, Braunwald E. The relationship between the TIMI frame count and clinical outcomes after thrombolytic administration. Circulation 1999;99:1945–1950. 4. Manginas A, Gatzov P, Chasikidis C, Voudris V, Pavlides G, Cokkinos DV. Estimation of coronary flow reserve using the Thrombolysis in Myocardial Infarction (TIMI) frame count method. Am J Cardiol 1999;83:1562–1565. 5. Gibson CM, Cannon CP, Murphy SA, Ryan KA, Mesley R, Marble SJ, McCabe CH, Van de Werf F, Braunwald E, for the TIMI Study Group. The relationship of the TIMI myocardial perfusion grade to mortality following thrombolytic administration. Circulation 2000;101:125–130. 6. Stata Corp. Stata Statistical Software: Release 6.0. College Station, Texas. Stata Corporation, 1999. 7. Gibson CM, Murphy SA, Menown I, Sequeira RF, Greene R, Van de Werf F, Schweiger MJ, Ghali M, Frey M, , et al, for the TIMI Study Group. Determinants of coronary blood flow following thrombolytic administration. J Am Coll Cardiol 1999;34:1403–1412. 8. Leosco D, Fineschi M, Pierli C, Fiaschi A, Ferrara N, Bianco S, Longobardi G, Pisani E, Bravi A, Rengo F. Intracoronary serotonin release after high-pressure coronary stenting. Am J Cardiol 1999;84:1317–1322. 9. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, Brodie BR, Madonna O, Eijgelshoven M, Lansky AJ, O’Neill WW, Morice MC. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1999;341:1949 –1956. 10. Lansky AJ, Stone GW, Mehran R, Popma JJ, Hanzel G, Summers N, Bao Bui A, Satler LF, Mattos L, Cox MCM, Leon MB, Grines CL. Impact of baseline TIMI flow on outcomes after primary stenting versus primary PTCA in acute myocardial infarction. Results from PAMI stent. J Am Coll Cardiol 1999; 33(suppl A):368A. 11. Neumann F-J, Blasini R, Schmitt C, Alt E, Dirschinger J, Gawaz M, Kastrati A, Scho ¨mig A. Effect of glycoprotein IIb/IIIa receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation 1998;98:2695–2701. Local Recruitment of LFA-1  Lymphocytes After Coronary Stent Implantation Marino Paroli, MD, Antonio Nigri, MD, Francesco Pizzuto, MD, Rosalba Benvenuto, MD, Angela Gurgo, MD, Gennaro Sardella, MD, Francesca Fravolini, MD, Andrea Berni, MD, and Stefano Villatico-Campbell, MD R estenosis after successful revascularization by percutaneous transluminal coronary angioplasty (PTCA) represents a major problem limiting the clin- ical efficacy of this procedure. 1 Although coronary artery stenting has definitely been proved to improve results of PTCA in a large number of patients, in-stent restenosis remains a significant clinical problem. 2 Coronary stent implantation is invariably accompa- nied by a certain degree of endothelium damage. This may be induced by ischemia/reperfusion because of the short periods of blood flow reduction during the procedures, or by plaque rupture. 3,4 Both events trig- ger endothelium to express adhesion molecules at high From the Dipartimento di Medicina Interna, and Istituto di Chirurgia del Cuore e dei Grossi Vasi, Universita ` “La Sapienza,” 00161, Rome, Italy. Dr. Paroli’s address is: Istituto di I Clinica Medica, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy. E-mail: marino.paroli@uniroma1.it. Manuscript received October 24, 2000; revised manuscript received and accepted December 26, 2000. 1295 ©2001 by Excerpta Medica, Inc. All rights reserved. 0002-9149/01/$–see front matter The American Journal of Cardiology Vol. 87 June 1, 2001 PII S0002-9149(01)01525-9