应用药物球囊与药物洗脱支架治疗左主干再狭窄分叉病变的对比研究

目的对比应用药物球囊(DCB)血管成形术与再次植入药物洗脱支架(DES)治疗左主干再狭窄分叉病变对患者的长期影响。方法回顾性纳入2014年10月—2018年10月在天津市胸科医院因左主干再狭窄分叉病变行介入治疗的患者48例,其中DCB组24例,DES组24例,术前、术后均行冠状动脉造影定量分析,39例(81.3%)患者18个月随访再次行冠状动脉造影及冠状动脉造影定量分析,并对临床终点事件进行长期随访。结果基线资料分析表明,与DES组相比,DCB组非ST段抬高型心肌梗死或ST段抬高型心肌梗死患者比例相似(8.3%比25.0%,P=0.25);具有较高的低密度脂蛋白胆固醇水平[(92.9±35.1) mg/dL比(78.0±30.7) mg/dL,P=0.07],以及更多的双层支架病例(25.0%比4.2%,P=0.05),但均未达统计学意义。PCI后18个月冠状动脉造影定量分析随访,与DES组相比,DCB组晚期管腔丢失差异无显著性[(1.06±1.10) mm比(0.84±1.15) mm,P=0.62],靶病变最小管腔直径差异无显著性[(1.68±0.96) mm比(2.06±1.21) mm,P=0.37]。中位随访时间868天,主要不良心血管事件累计发生率DCB组为25.0%,DES组为29.2%,差异无统计学意义(P=0.75)。结论 DCB和DES在左主干再狭窄分叉病变患者中表现出相似的长期临床结局。     

左主干合并慢性完全闭塞病变介入治疗效果及三年随访分析

目的:探讨左主干(LM)合并慢性完全闭塞(CTO)病变患者经皮冠状动脉介入治疗(PCI)的效果及长期预后。方法:回顾性纳入2004年1月至2015年12月于中国医学科学院阜外医院行冠状动脉LM介入治疗的患者3 960例,按照LM病变是否合并CTO病变,分为LM合并CTO病变组(n=91)和LM不合并CTO病变组(n=3 869),比较两组患者的临床特点和长期预后。结果:与LM不合并CTO病变组患者相比,LM合并CTO病变组患者既往心肌梗死比例较高(26.1%vs. 40.7%),左心室射血分数较低[(63.1±7.7)%vs.(59.6±10.4)%],病变长度[(27.1±19.3)mm vs.(40.9±25.5)mm]及置入的支架长度[(31.9±19.8)mm vs.(45.8±27.1)mm]均较长,SYNTAX评分[(22.9±7.2)分vs.(27.2±7.3)分]较高,再狭窄病变(2.8%vs. 6.6%)、LM钙化病变(12.5%vs. 19.8%)、血栓性病变(1.1%vs. 13.2%)比例及主动脉内球囊反搏应用率(7.4%vs. 16.5%)、介入操作并发症发生率(2.0%vs. 5.5%)均较高,上述差异均有统计学意义(P均0.05)。所有患者中3年全因死亡率为3.5%。Kaplan-Meier生存分析显示,LM合并CTO病变组3年全因死亡率(11.0%vs. 3.4%)和心肌梗死发生率(13.2%vs. 4.1%)均明显高于LM不合并CTO病变组(P均0.05)。结论:PCI对适宜的LM病变是可选择的治疗方法,但对于LM合并CTO病变患者,PCI并发症发生率较高,不良心脏事件明显增加,因此此类患者应慎行PCI。     

药物涂层球囊治疗糖尿病患者冠状动脉大血管原位病变的疗效与安全性分析

目的:比较药物涂层球囊(DCB)与药物洗脱支架(DES)在糖尿病患者冠状动脉(冠脉)大血管原位病变的应用效果。方法:回顾性分析郑州大学第五附属医院心血管内科2019年10月—2020年10月收治糖尿病伴冠状动脉大血管病变患者122例,按手术方式分为DCB组和DES组。术前、术后即刻及术后6个月分别进行选择性定量冠脉造影,观察两组患者靶病变最小管腔直径、管腔残余狭窄率、管腔增加及晚期管腔丢失等指标。术后随访两组6个月的靶病变血运重建率、主要不良心血管事件(MACE)及出血事件。结果:术后即刻靶血管最小管腔直径、管腔残余狭窄率及管腔即刻获得,DES组分别为(3.26±0.35) mm、(2.8±1.4)%、(2.64±0.22) mm, DCB组分别为(2.82±0.22) mm、(14.5±5.0)%、(2.21±0.26) mm,差异有统计学意义(P<0.001)。DCB组靶血管晚期管腔丢失小于DES组,差异有统计学意义(P<0.001)。随访期间,DCB组靶病变血运重建率及MACE发生率分别为3.4%、3.5%,DES组靶病变血运重建率及MACE发生率分别为6.0%、9....     

冠心病合并2型糖尿病药物洗脱支架置入远期预后及影响因素研究

目的观察冠心病合并2型糖尿病(DM)患者置入药物洗脱支架(DES)的远期预后及其影响因素分析。方法入选2006年3月至2009年3月沈阳医学院沈洲医院冠心病合并DM患者253例,首次冠脉介入(PCI)治疗置入DES,随访12个月以上,记录主要不良心血管事件(MACE)及支架内血栓(ST),支架内再狭窄,再发心绞痛发生情况。结果平均随访时间为(13.1±3.6)个月,42例(17.87%)发生MACE、ST及再发心绞痛,发生事件组冠心病家族史,既往急性心肌梗死者,左主干PCI,多支血管病变,CTO病变,病变数及重度病变明显多于非事件组(P0.05);急性心肌梗死及CTO为影响远期预后的独立危险因素。结论对于冠心病合并DM患者DES可降低再狭窄率,患者远期预后与自身病情及病变有关,综合危险因素管理更为重要。     

虚拟组织学-血管内超声分析冠状动脉慢性完全闭塞病变斑块特征

目的探讨稳定型心绞痛患者冠状动脉慢性完全闭塞(CTO)病变斑块虚拟组织学-血管内超声(VH-IVUS)的特征。方法回顾性研究2015年8月至2018年6月在湘潭市中心医院心内科住院行VH-IVUS分析的95例稳定型心绞痛患者,其中40例为CTO病变患者作为CTO组,55例为非CTO病变患者作为非CTO组。比较两组患者的基线资料和病变VH-IVUS特点。结果 CTO组患者病变近端参考截面的管腔面积[(7.30±1.83)mm2比(9.93±5.87)mm2,P=0.008]、病变远端参考截面的管腔面积[(5.16±1.76)mm2比(7.12±4.19)mm2,P=0.006]均显著小于非CTO组患者。使用VHIVUS测量两组的病变长度发现,CTO组患者病变长度明显长于非CTO组患者[(19.63±5.34)mm比(15.78±7.99)mm,P=0.010]。CTO组患者经球囊扩张后的病变血管最小管腔面积与非CTO组患者比较[(4.14±1.61)mm2比(4.37±1.47)mm2,P=0.871],差异无统计学意义。两组患者在病变血管最小管腔截面的血管重构指数、斑块面积、斑块负荷、斑块组成及其所占比例比较,差异均无统计学意义(均P0.05)。CTO组患者病变近端斑块负荷[(50.35±14.83)%比(40.44±12.32)%,P=0.001]、远端斑块负荷[(43.65±12.20)%比(39.02±8.20)%,P=0.036)]均显著大于非CTO组患者。CTO组患者病变总体纤维组织体积[(65.98±13.59)mm3比(55.25±14.89)mm3, P0.001]、钙化组织体积[(9.40±3.18)mm3比(5.58±2.77)mm3, P0.001]、坏死核体积[(18.60±6.19) mm3比(15.51±5.73)mm3, P=0.014]均显著高于非CTO组患者,差异均有统计学意义。通过病变长度校正后,比较两组患者斑块病理组织体积发现,每毫米纤维组织、每毫米纤维脂质组织、每毫米钙化组织和每毫米坏死核体积比较,存在一定的差别,但差异均无统计学意义。结论在稳定型心绞痛患者中,与非CTO病变相比,CTO病变长度更长并且斑块负荷更重。通过病变长度校正后,CTO病变与非CTO病变的病理组织构成比例大致相同。     

冠状动脉造影联合血流储备分数在2型糖尿病女性冠心病患者介入治疗中的应用价值

目的探讨冠状动脉造影(CAG)联合血流储备分数(FFR)在2型糖尿病女性冠心病患者介入治疗中的临床应用价值。方法选取2014年1月至2015年7月在航天中心医院接受CAG检查、证实至少有1处冠状动脉狭窄70%、拟置入支架治疗的女性患者60例,均确诊为2型糖尿病,随机分为观察组28例和对照组32例。观察组共42处病变均应用压力导丝行心肌FFR测定,仅在FFR≤0.80的病变中置入药物洗脱支架(DES);对照组共51处病变常规置入DES。比较两组患者冠心病危险因素情况、置入支架数,手术后12个月主要不良心血管事件(MACE,包括全因死亡、非致死性心肌梗死、再次血运重建及因心脏原因再入院)发生率及心绞痛再发率。结果观察组28例患者,FFR≤0.80的有12例患者18处病变共置入DES 19枚;对照组32例患者51处病变共置入DES48枚。观察组平均住院费用[(2.43±1.02)万元比(5.54±2.11)万元,P=0.005]、平均置入支架数[(0.68±0.64)枚比(1.49±0.88),P=0.032]、平均手术时间[(58.4±18.1)min比(68.4±21.2)min,P=0.041]及平均对比剂用量[(148.8±32.0)ml比(197.9±45.4)ml,P=0.028]均少于对照组,差异均有统计学意义。随访12个月,观察组再发心绞痛4例(14.3%),MACE事件2例(7.1%);对照组再发心绞痛4例(12.5%),MACE事件3例(9.3%),两组再发心绞痛和MACE的发生率比较,差异均无统计学意义(均P0.05)。结论 2型糖尿病女性冠心病患者介入治疗中联合应用CAG和FFR监测,可减少术中支架置入数量及对比剂用量,且并不增加近期不良心血管事件的发生率。     

药物涂层球囊在急性ST段抬高型心肌梗死中应用的有效性及安全性研究

目的探讨药物涂层球囊在急性ST段抬高型心肌梗死(STEMI)患者中应用的有效性及安全性。方法回顾性分析阜外华中心血管病医院明确诊断为STEMI并接受急诊介入治疗及有效随访患者106例,其中34例给予药物涂层球囊(DCB)治疗,72例给予药物洗脱支架(DES)治疗,随访 10个月并复查冠状动脉(冠脉)造影,比较两组靶病变再血管化率(TLR)、靶血管再血管化率(TVR)、晚期管腔直径丢失率(LLL)及再发心绞痛、再发心肌梗死、心源性死亡、卒中等不良事件发生率。结果两组均无TVR事件发生,TLR相比无显著差异(2.9% vs.2.8%,P0.05),晚期管腔直径丢失DCB组优于DES组[-(0.037±0.071)mm vs.(0.135±0.358)mm,P0.05],差异有统计学意义,复查冠脉造影DCB组晚期最小管腔直径获得优于DES组,差异无统计学意义[(0.033±0.132)mm vs.-(0.041±0.535)mm,P0.05],DCB组术后即刻残余狭窄劣于DES组[(9.76±5.064)% vs.(2.26±3.206)%,P0.05],差异有统计学意义。结论药物涂层球囊在STEMI患者中的应用有效且相对安全。     

血管内超声成像在冠脉左主干复杂病变介入治疗中的作用

目的:研究血管内超声成像(IVUS)在冠脉左主干复杂病变介入治疗中的作用。方法:我院的102例需行经皮冠状动脉介入治疗(PCI)的冠脉左主干复杂病变患者被随机均分为常规造影组(PCI术中行常规冠脉造影)与IVUS组(PCI术中行IVUS)。观察比较两组PCI治疗指标、冠脉左主干最小管腔面积(MLA)、最小管腔直径(MLD)、面积狭窄率(AS)、置入支架参数及随访12个月主要不良心血管事件(MACE)发生率。结果:与常规造影组比较,IVUS组冠脉左主干MLD[(1.63±0.75)mm比(2.18±0.61)mm], MLA[(2.50±0.96)mm~2比(4.95±1.21)mm~2],置入支架直径[(3.35±0.29)mm比(3.55±0.28)mm]、长度[(12.10±4.21)mm比(14.43±5.03)mm],治疗后扩张球囊直径[(3.78±0.39)mm比(3.98±0.51)mm]、压力[(14.45±2.48)atm比(17.05±2.81)atm]均显著升高,AS[(77.34±7.41)%比(63.25±8.16)%]显著降低,P0.05或0.01。随访12个月,IVUS组MACE发生率显著低于常规造影组(13.73%比37.25%,P=0.006)。结论:IVUS能显著提高冠脉左主干复杂病变介入治疗的精准性及疗效。     

药物洗脱支架对完全闭塞性病变介入治疗预后影响的评估

目的比较对于完全性闭塞病变采用药物洗脱支架和金属裸支架的近期和远期预后。方法选择我院近期连续接受置入药物洗脱支架(DES)或金属裸支架(BMS)治疗,并且进行冠状动脉造影随访的155例存在完全闭塞病变的冠心病患者。患者在支架术后6个月左右接受冠状动脉造影随访。结果共155例患者(138名男性,17名女性)159处靶病变置入232枚支架完成造影随访,其中慢性完全性闭塞65例,占41.9%。其中C型病变占总数的85.4%。在患者基本条件方面,DES组2型糖尿病比例要多于BMS组(33.8%比18.5%,P=0.030)。在病变基本条件方面,DES组和BMS组C型病变分别占89.6%和72.0%(P=0.005),DES组病变更为复杂。DES组慢性完全闭塞病变比例明显高于BMS组(60.3%比24.4%,P<0.001)。DES组和BMS组的支架长度和病变长度没有差别。DES组参考血管直径小于BMS组[(2.72±0.36)mm比(2.96±0.52)mm,P=0.001]。6个月随访结果显示支架再狭窄DES组明显低于BMS组(15.6%比41.5%,P<0.001)。DES组支架再狭窄更多为局限性(58.3%比17.6%,P<0.001)。DES组的靶病变血管重建率明显低于BMS组(5.8%比19.9%,P=0.001)。病变内晚期腔径丢失DES明显小于BMS[(0.36±0.63)mm比(1.04±0.70)mm,P<0.001]。晚期支架内血栓DES有2例,BMS为0。DES组有1例死亡。术后主要心脏不良事件发生率两组分别是1.4%和11.1%,DES组显著低于BMS组(P=0.032)。结论我们的研究发现对于完全闭塞性病变的治疗,DES有着良好的治疗效果,比BMS有着明显减低的再狭窄率、靶病变血管重建率,并且在随访期间患者有着更少的心血管事件。     

斑块组成对晚期药物支架贴壁不良影响的虚拟组织学血管内超声研究

目的探讨基线斑块组成对药物洗脱支架(drug-eluting stent,DES)置入术后晚期支架贴壁不良(late stent malapposition,LSM)的影响。方法入选不稳定性心绞痛患者76例(113处病变)行冠状动脉原位病变DES置入及基线和随访虚拟组织学血管内超声检查,分为LSM组11例和无LSM组65例。结果 11例患者有16处(14.2%)病变,随访时发现LSM。不同DES比较,差异无统计学意义(P>0.05)。LSM组糖尿病(63.6%vs29.2%,P<0.05)、支架长度[(29.4±5.5)mmvs(26.2±6.0)mm,P<0.05]、坏死核心体积[(29.8±14.0)mm3 vs(21.4±9.5)mm3,P<0.01]及坏死核心体积百分比[(26.5±6.6)%vs(20.1±6.6)%,P<0.01]均明显高于无LSM组。多因素回归分析显示,坏死核心体积百分比(OR=1.144,95%CI:1.052¹.243,P=0.002)和糖尿病(OR=3.829,95%CI:1.1581.243,P=0.002)和糖尿病(OR=3.829,95%CI:1.158¹2.663,P=0.028)是LSM的独立预测因素。结论病变坏死核心成分和糖尿病与不稳定性心绞痛DES置入术后LSM形成有关。     

Immediate and mid-term outcomes of sirolimus-eluting stent implantation for chronic total occlusions.

AIMS: To evaluate the outcomes of sirolimus-eluting stent (SES) implantation for the treatment of chronic total occlusion (CTO). METHODS AND RESULTS: We identified 122 patients who underwent revascularization in CTO lesions with SES from April 2002 to April 2004 (SES group). A control group was composed of 259 consecutive patients with CTO lesions treated with bare metal stents (BMS) in the 24 months immediately before the introduction of SES (BMS group). At 6-month follow-up, the cumulative rate of major adverse cardiac events (MACE) was 16.4% in the SES group and 35.1% in the BMS group (P<0.001). The incidence of restenosis was 9.2% in the SES group and 33.3% in the BMS group (P<0.001). The need for revascularization in the SES group was significantly lower, both target lesion revascularization (7.4 vs. 26.3%, P<0.001) and target vessel revascularization (9.0 vs. 29.0%, P<0.001). BMS implantation (HR: 2.97; 95% CI: 1.80-4.89; P<0.001), lesion length (>20 mm) (HR: 2.02; 95% CI: 1.37-2.99; P=0.0004), and baseline reference vessel diameter (>2.8 mm) (HR: 0.62; 95% CI: 0.42-0.92; P=0.02) were identified as predictors of MACE during 6-month follow-up. CONCLUSION: Compared with BMS, SES implantation in CTO lesions appears to be effective in reducing the incidence of restenosis and the need for revascularization at 6 months.     

Percutaneous coronary intervention with drug-eluting stent implantation vs. minimally invasive direct coronary artery bypass (MIDCAB) in patients with left anterior descending coronary artery stenosis.

The aim of this study was to assess the effects of percutaneous coronary intervention with drug-eluting stents (DESs) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery in the management of patients with proximal left anterior descending (LAD) coronary artery stenosis. Until recent years, despite the advantages of percutaneous transluminal coronary angioplasty (PTCA) with bare metal stent implantation, such as shorter hospital stays and recovery time, MIDCAB showed better results with regard to the need for repeated intervention in the target vessel than PTCA with proximal LAD lesions. Symptomatic patients (n = 189) were randomly assigned to DES group (n = 119) and MIDCAB group (n = 70). Patients with an isolated high-grade lesion (stenosis of > or = 70% of the luminal diameter) in the proximal LAD coronary artery (from the ostium to the first diagonal branch) were included in this study. During the 6-month follow-up period, 1.7% (n = 2) in the DES group needed repeated revascularization procedures for target lesion revascularization compared with 5.9% (n = 4) in the MIDCAB group (P = 0.196). The rates of death and myocardial infarction were similar in both groups [DES 0.0% (n = 0) vs. MIDCAB 2.9% (n = 2), P = 0.135; DES 1.7% (n = 2) vs. MIDCAB 2.9% (n = 2), P = 0.627; respectively] during 6 months of follow-up. In-hospital length of stay was significantly shorter in the DES group compared with the MIDCAB group (5.8 +/- 2.1 days vs. 8.9 +/- 2.6 days; P = 0.001). DES implantation and MIDCAB surgery showed similar rates of myocardial infarction, the need for repeated revascularization, and death during 6 months of follow-up. However, DES implantation resulted in lower average number of hospital stays and similar postoperative complications.     

Drug-eluting stent-supported percutaneous coronary intervention for chronic total coronary occlusion.

OBJECTIVES: This study sought to determine the clinical and angiographic outcomes after drug-eluting stent (DES)-supported percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO). BACKGROUND: There are few data about the efficacy of DES-supported PCI for CTO. METHODS: All consecutive patients who had a sirolimus-eluting stent or a paclitaxel-eluting stent implanted for CTO from December 2003 to December 2004 were analyzed. Clinical and angiographic outcomes of patients treated with DES were compared with a case-matched control group of patients treated with bare metal stents (BMS) in the 12 months before the routine use of DES. RESULTS: Successful DES-supported PCI was performed in 92 patients and 104 CTO. The case-matched control group consisted of 26 patients and 27 CTO successfully treated with BMS. There were no differences between groups in baseline clinical and angiographic characteristics. Stent length in the DES group was higher as compared with that of BMS group (51+/-28 mm vs. 40+/-19 mm, P=0.073). The 6-month major adverse cardiac event (MACE) rate was lower in the DES group as compared with that of BMS group (9.8% vs. 23%, P=0.072). The angiographic follow-rate was 80% in the DES group and 81% in the BMS group. The 6-month restenosis rate was 19% in the DES group and 45% in the BMS group (P<0.001). By multivariate analysis, it was found that in the DES group, the only predictors of restenosis were stented segment length (OR 1.031, 95% CI 1.01-1.06, P=0.009) and a target vessel reference diameter<2.5 mm (OR 6.48, 95% CI 1.51-27.83, P=0.012), while the only predictor of MACE was stent length (OR 1.04, 95% CI 1.01-1.08, P=0.006). CONCLUSIONS: DES implantation for CTO decreases the risk of mid-term restenosis and MACE. Small vessels and diffuse disease requiring the implantation of multiple stents and very long stents for full coverage of the target lesion are still associated with a relatively high risk of restenosis.     

Clinical outcome of patients with chronic total occlusion treated with drug-eluting stents

BACKGROUND: There is limited evidence on the medium-term prognosis of patients with chronic total occlusion successfully treated with drug-eluting stent (DES) implantation. METHODS: We compared the medium-term outcome of 111 patients with chronic total occlusion (CTO) successfully treated with implantation of sirolimus-or paclitaxel-eluting stents versus 112 patients treated with bare metal stents. RESULTS: During an overall follow-up period of 18 months, the composite endpoint of death, myocardial infarction or target lesion revascularization was significantly lower in the drug-eluting stent than in the bare metal stent group: 8.1% vs. 21.6%, respectively (p=0.005). The difference was due to the reduction of target lesion revascularization with DES compared to bare metal stents: 3.6% vs. 18.9%, respectively (p<0.001). The Cox proportional hazards model identified DES as an independent predictor of adverse cardiac events (adjusted hazard ratio, 0.16; 95% confidence interval 0.05 to 0.52, p=0.002). CONCLUSIONS: During medium-term follow-up use of DES is associated with improved outcome compared to use of bare metal stents in patients with CTO.     

Immediate procedural and long-term clinical outcomes following drug-eluting stent implantation to ostial saphenous vein graft lesions

BACKGROUND: Ostial saphenous vein graft (OSVG) lesions were excluded from all the clinical trials demonstrating significantly lower restenosis rates with drug-eluting stents (DES) compared to bare metal stents (BMS). This study aimed to evaluate the efficacy of DES in OSVG lesions by assessing angiographic and 12-month clinical outcomes. METHODS: 70 consecutive patients (70 OSVG lesions) underwent coronary stent implantation between May 2003 and April 2006: 37 lesions received DES and 33 lesions BMS. Endpoints were all cause and cardiovascular mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), examined separately and as a combined end-point (major adverse cardiac events, MACE). RESULTS: Procedural (94.6% for DES and 87.9% for BMS) and angiographic (100% for DES and 100% for BMS) success did not differ between the two groups. The only in-hospital events were non-Q wave MI (DES 8.1% versus BMS 12.1%, P=0.69). At 30-day follow-up, there were no other events. Overall, at 1-year follow-up, the BMS group had a higher TLR (30.3% versus 5.4%, P=0.015), TVR (33.3% versus 10.8%, P=0.045) and MACE rate (36.4% versus 10.8%, P=0.024) compared to the DES group. CONCLUSIONS: Drug-eluting stent implantation to OSVG lesions achieves better clinical results than BMS but is still associated with a relatively high incidence (10.8%) of revascularization at 1-year follow-up.     

Treatment of saphenous vein graft lesions with drug-eluting stents: immediate and midterm outcome

OBJECTIVES: The purpose of the present report was to evaluate clinical and angiographic outcomes of drug-eluting stent (DES) implantation in saphenous vein graft (SVG) lesions. BACKGROUND: The safety and efficacy of DES implantation for the treatment SVG lesions remains uncertain. METHODS: We evaluated in-hospital and six-month outcomes in 61 consecutive patients treated with DES in SVG lesions from March 2002 to March 2004 (DES group), as compared to 89 consecutive patients treated with bare-metal stents (BMS) in the 24 months immediately before the introduction of DES (BMS group). Major adverse cardiac events (MACE) including death, myocardial infarction, target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and at six-month follow-up. RESULTS: The rate of in-hospital MACE was similar between the two groups (6.6% vs. 5.6%, p = 1.0). Cumulative MACE at six months was 11.5% in the DES group and 28.1% in the BMS group (p = 0.02). The DES group had a significantly lower incidence of in-segment restenosis (10.0% vs. 26.7%, p = 0.03), TLR (3.3% vs. 19.8%, p = 0.003), and TVR (4.9% vs. 23.1%, p = 0.003). By Cox regression analysis, diabetes (hazard ratio [HR]: 3.03; 95% confidence interval [CI]: 1.33 to 6.90; p = 0.008), usage of BMS (HR: 2.53; 95% CI: 1.07 to 5.97; p = 0.03), and age of SVG (HR: 1.10; 95% CI: 1.02 to 1.19; p = 0.02) were identified as predictors of MACE at six-month follow-up. CONCLUSIONS: Compared to BMS implantation, DES implantation in SVG lesions appears safe with favorable and improved mid-term outcomes.     

Comparison between drug-coated balloon angioplasty and second-generation drug-eluting stent placement for the treatment of in-stent restenosis after drug-eluting stent implantation

Even though drug-coated balloon (DCB) angioplasty has emerged as a treatment option for drug-eluting stent in-stent restenosis (DES–ISR), the most effective treatment strategy for DES–ISR is still under debate. Therefore, we compared long-term clinical outcomes following DCB treatment of DES–ISR with those following 2nd-generation drug-eluting stent (DES) treatment. We identified 248 DES–ISR lesions in 238 patients that were treated with either 2nd-generation DES implantation (n = 56) or DCB angioplasty (n = 192). We compared the incidences of major adverse cardiac events (MACEs) in the two groups during the 2-year period following treatment. MACE was defined as cardiac death, non-fatal myocardial infarction, or target-vessel revascularization. The percentage of patients with diabetes and the mean age of patients in the DCB group were greater than in the DES group. The DCB group also had a smaller reference vessel diameter. The DES group had a larger post-intervention minimal luminal diameter. We found no significant difference in the MACE rate between the two groups during the 2 years following treatment (11.0 % in the DCB group vs. 8.9 % in the DES group, p = 0.660). Reference segment diameter was the only independent predictive factor for MACE in the post-treatment period (hazard ratio 0.35, 95 % confidence interval: 0.15–0.82, p = 0.016). Clinical efficacy of DCB angioplasty for treatment of DES–ISR was comparable to that of 2nd-generation DES implantation as measured by the rate of MACEs in the two groups. Reference segment diameter was the only statistically significant independent predictor for MACE in the 2-year period following treatment.     

Relation of fractional flow reserve after drug-eluting stent implantation to one-year outcomes

Patients still present with drug-eluting stent (DES) failure despite an angiographically successful implantation. The aim of the present study was to investigate the relation between the fractional flow reserve (FFR) measured after DES implantation and the clinical outcomes at 1 year. A total of 80 patients (mean age 62 years, 74% men, 99 DESs) underwent coronary pressure measurement at maximum hyperemia after successful DES implantation. The composite of major adverse cardiac events (MACE), including death, myocardial infarction, and ischemia-driven target vessel revascularization was evaluated at 1 year. The patients were divided into 2 groups (low-FFR group, FFR ≤0.90 and high-FFR group, FFR >0.90) according to the median FFR. The mean poststent percent diameter stenosis was 11 ± 5% in the low-FFR group and 12 ± 3% in the high-FFR group (p = 0.31). Left anterior descending coronary artery lesions were more frequent in the low-FFR group than in the high-FFR group (82% vs 55%, p = 0.02). The mean stent length was greater in the low-FFR group than in the high-FFR group (38 ± 18 vs 28 ± 13 mm, p = 0.01). Six cases (7.5%) of MACE occurred during the 1-year follow-up. The rate of MACE was 12.5% in the low-FFR group and 2.5% in the high-FFR group (p <0.01). Receiver operating characteristic curves revealed 0.90 as the best cutoff of FFR after DES implantation for the prediction of 1-year MACE. In conclusion, a poststent FFR of ≤0.90 correlated with a greater adverse event rate at 1 year.     

Comparison of one-year cardiac events with drug-eluting versus bare metal stent implantation in rescue coronary angioplasty

Rescue percutaneous coronary intervention (PCI) with bare metal stent (BMS) implantation is useful in patients with acute myocardial infarction (AMI) and failed thrombolysis. Drug-eluting stent (DESs) are more effective in reducing restenosis compared to BMS. No data are available comparing the clinical outcomes between the 2 types of stents nor has information ever been provided about the predictors of events in patients treated with rescue PCI in the current era. The aims of the present study were to evaluate the outcomes of patients undergoing rescue PCI with DES implantation compared to BMS implantation and to determine the independent predictors of events during 1 year of follow-up. The study population consisted of 311 consecutive patients with ST-segment elevation AMI and evidence of failed fibrinolysis undergoing successful revascularization with DES (n = 134) or BMS (n = 177) implantation. The end point of the present study was the incidence of major adverse cardiac events (MACE) defined as death, recurrent AMI, and target vessel revascularization. No differences were found in the number of MACE at 1 year of follow-up between the DES and BMS groups (n = 10 and 19, respectively, p = 0.29). The Cox proportional hazards model identified cardiogenic shock (adjusted hazard ratio 7.05, 95% confidence interval 2.08 to 23.9, p = 0.001), age (hazard ratio 1.51, 95% CI 1.09 to 2.08, p = 0.011), and final minimal lumen diameter (hazard ratio 0.42, 95% confidence interval 0.21 to 0.83, p = 0.013) as independent predictors of MACE at 1 year of follow-up. After propensity score adjustments, the predictors did not change. In conclusion, we found no differences between DESs and BMSs with respect to MACE at 1 year of follow-up in patients with AMI treated with rescue PCI. Cardiogenic shock, age, and final minimal luminal diameter were identified as predictors of MACE.     

Results and predictors of angiographic restenosis and long-term adverse cardiac events after drug-eluting stent implantation for aorto-ostial coronary artery disease

The correlates of angiographic and clinical outcomes after drug-eluting stent (DES) implantation for aorto-ostial lesions remain unknown. This study evaluated long-term results of DES implantation for aorto-ostial lesions and determined risk factors for restenosis and adverse cardiac events. In total, 184 consecutive patients who underwent DES implantation for aorto-ostial lesions were investigated (DES group) compared with 172 consecutive patients treated with bare metal stents before the introduction of DESs (pre-DES group). Major adverse cardiac events (MACEs) were defined as death, Q-wave myocardial infarction, and need for target lesion revascularization. The DES group had significantly higher risk clinical and procedural profiles than the pre-DES group. Procedural success rates were 99.5% in the DES group and 100% in the pre-DES group (p = 1.0). The DES group had a significantly lower incidence of in-segment restenosis (10.5% vs 26.0%, p = 0.001) and target lesion revascularization (4.3% vs 11.6%, p = 0.011). Cumulative MACE rates at 1 year were 6.5% in the DES group and 13.4% in the pre-DES group (p = 0.03). By multivariate analysis, treatment of bypass graft, treatment of in-stent restenosis, and reference vessel diameter were predictors of restenosis, and only reference vessel diameter (hazard ratio 0.20, 95% confidence interval 0.05 to 0.75, p = 0.017) inversely correlated with 1-year MACEs after DES implantation. In conclusion, DES implantation for aorto-ostial lesions is associated with a significant decrease in restenosis and MACEs compared with the pre-DES phase. Treatment of bypass graft and in-stent restenosis and reference vessel size were identified as predictors of restenosis and/or long-term MACEs after DES implantation.