胎盘生长因子对评估冠心病患者冠脉病变的价值

目的探讨胎盘生长因子(PLGF)在冠心病患者冠状动脉支架置入术前后中的表达及其对评估冠脉病变严重程度的价值。方法 2010年11月至2011年4月入住本院心血管内科胸痛患者与同期健康体检者,测定其血浆PLGF水平。按冠脉造影结果分为冠心病组与非冠心病组;按是否行冠脉支架置入术把冠心病组分为支架置入组(PCI组)、非支架置入组(非PCI组);按累及冠脉病变血管数把冠心病组分为单支组、双支组、多支组,测定其术前与术后第1天的PLGF水平。结果 1)冠心病组术前PLGF明显高于非冠心病组与对照组,差异有统计学意义(P<0.01);2)术前与术后PLGF水平在PCI组明显高于非PCI组,但均低于各自组术前,P<0.05;3)在术前血浆PLGF水平多支组明显高于单支组与双支组,术后三组PLGF水平均明显低于术前,P<0.05,而术前单支组、双支组之间与术后上述三组各自间差异无统计学意义(P>0.05);4)单支组、双支组、多支组比较,行PCI的PLGF水平均高于非PCI组,P<0.05。结论检测血浆PLGF水平在胸痛的鉴别诊断中具有一定意义,有助于冠心病的早期诊断;需要血运重建的冠状动脉病变PLGF水平明显增高,且通过冠状动脉支架置入术后PLGF水平均明显回落,能初步评估冠脉病变的严重程度。     

全降解涂层雷帕霉素药物洗脱冠状动脉支架治疗急性冠脉综合征的疗效及安全性研究

目的 研究全降解涂层雷帕霉素药物洗脱冠状动脉支架(TIVOLI支架)治疗急性冠脉综合征的疗效及安全性.方法 选择我院收治的80例急性冠脉综合征且行冠状动脉造影检查的患者,根据置入支架类型分为TIVOLI组和EXCEL组,并行冠状动脉介入治疗(PCI).跟踪随访6个月,观察两组主要心脏不良事件(MACE)及支架内再狭窄发生情况.结果 两组患者均成功实施PCI治疗并配合临床随访,其中TIVOLI组2例患者随访3个月时因外科手术退出随访,EXCEL组1例患者术后3d心源性死亡退出随访,其余均完成了随访.两组患者MACE的发生率分别为7.5%及5.0%,差异无统计学意义(P＞0.05).结论 TIVOLI支架治疗急性冠脉综合征患者疗效及安全性与EXCEL支架无明显差异.     

血浆D-二聚体水平与急性心肌梗死及冠状动脉病变程度的相关性

目的：探讨急性心肌梗死以及冠状动脉病变程度与血浆D-二聚体的相关性。方法：收集 2015年8月至2017年4月入住安徽医科大学第一附属医院心内科且资料完整的急性心肌梗死组(AMI组)患者110例,同期入住并行冠脉造影检查阴性的非急性心肌梗死组(非AMI组)患者100例,观察两组间D-二聚体差别,同时根据造影结果,计算 AMI组冠脉病变支数以及Gensini评分,观察其与D-二聚体的相关性。结果：①AMI组D-二聚体水平0.77±0.34(mg/L)明显高于非AMI组0.30±0.14(mg/L),差异有统计学意义(P<0.05);②冠脉三支病变组D-二聚体水平0.97±0.37(mg/L)高于单支0.52±0.25(mg/L)以及双支病变组0.75±0.20(mg/L),差异有统计学意义(P<0.05),冠脉双支病变组D-二聚体水平高于单支病变组,差异有统计学意义(P<0.05);③AMI组D-二聚体水平与Gensini评分呈正相关(r=0.516,P<0.05)。结论：血浆D-二聚体水平在AMI患者中要高于非AMI患者,同时D-二聚体水平可反映冠脉病变程度。     

血浆P-选择素和内皮素-1预测冠状动脉内支架术后早期再狭窄的价值

目的探讨急性冠状动脉综合征(ACS)患者经皮介入治疗(PCI)术后血浆P-选择素及内皮素-1(ET-1)的动态变化对预测术后发生支架内再狭窄的价值。方法对108例行PCI手术的ACS患者,分别于术前和术后即刻、1周、2周、1个月、3个月、6个月采集外周静脉血,4℃离心分离血浆,-70℃保存备测。所有患者术后6个月常规行冠状动脉(冠脉)造影(CAG)。根据冠脉造影结果分为冠脉再狭窄组和无再狭窄组,并分析两组血浆P-选择素及ET-1的水平。结果随访中4例患者死亡,均为急诊PCI患者,4例失访,余100例根据冠脉造影结果分为冠脉再狭窄组(n=16)和无再狭窄组(n=84)。两组ACS患者血浆P-选择素及ET-1在术后即刻达高峰,较术前明显增加,冠脉无再狭窄组术后24h恢复至术前水平,2周降至正常,术后1个月、3个月、6个月在正常基线范围内上、下波动。冠脉再狭窄组血浆P-选择素和ET-1术后2周没有降至正常,而呈持续性升高,并在术后3~6个月出现第2次高峰,与无再狭窄组相比差异有统计学意义。结论ACS患者PCI术后早期(1~2周)P-选择素及ET-1持续升高,并在术后3~6个月出现第2次高峰,则冠脉发生再狭窄的危险性高。P-选择素及ET-1可作为预测早期冠脉再狭窄的参考指标。     

冠状动脉粥样硬化性心脏病患者择期支架植入术前血浆超敏C反应蛋白水平对术后6个月支架内再狭窄及12个月急性冠脉事件发生的预测价值

目的 探讨冠状动脉粥样硬化性心脏病(简称冠心病)患者支架植入术前血浆超敏C反应蛋白(hs-CRP)水平与术后6个月支架内再狭窄及12个月急性冠脉事件发生的关系.方法 选择2007年10月～2010年2月我院住院的行经皮冠状动脉介入治疗(PCI)的冠心病患者358例,通过测定支架植入术前患者血浆hs-CRP水平,初步采用Logistic回归分析冠心病患者术前hs-CRP水平和PCI术后6个月后支架内再狭窄和随访12个月急性冠脉事件发生的关系.结果 血浆hs-CRP水平和PCI术后随访12个月急性冠脉事件高度相关(OR=2.21,P ＜0.01);血浆hs-CRP水平和PCI术后6个月支架内再狭窄无明显相关(OR=1.17,P ＞0.05).结论 冠心病患者支架植入术前血浆hs-CRP水平和PCI术后急性冠脉事件的发生密切相关,但是和PCI术后支架内再狭窄无明显相关,支架植入术前血浆hs-CRP水平对PCI术后急性冠脉事件的发生有较好的预测价值.     

老年颈动脉狭窄患者行颈动脉支架术后血清炎症因子和凝血因子的变化

目的分析老年颈动脉狭窄患者行颈动脉支架术后血清炎症因子和凝血因子的变化情况。方法选择83例颈动脉狭窄患者作为研究对象,根据是否接受介入治疗将其分为支架组(27例)和造影组(56例)。测定各组患者术前、术后1 d、术后3 d和术后1 w血清凝血因子和炎症因子水平,比较两组患者术前和术后不同时间血清凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-二聚体、纤维蛋白原降解产物(FDP)水平以及C-反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6水平变化情况。结果支架组和造影组患者手术后血清各凝血因子较手术前均有不同程度的变化(P0.05);支架组和造影组比较:支架组和造影组术前PT、APTT、FIB、D-二聚体和FDP水平比较均无统计学意义(P0.05);支架组术后1 d和术后3 d PT、D-二聚体和FDP水平均高于造影组(P0.05);支架组术后3 d APTT和FIB水平均高于造影组(P0.05);术后1 w时支架组和造影组各凝血指标均基本恢复术前水平,两组之间比较无显著差异(P0.05);支架组和造影组患者手术后血清各炎症因子较手术前均有不同程度的变化(P0.05),支架组术后炎症反应较造影组明显(P0.05)。结论老年颈动脉狭窄颈动脉支架术影响患者术后的血清炎症因子和凝血因子,该变化持续到术后1 w,之后逐渐恢复正常。     

高敏C-反应蛋白与冠脉病变程度及支架植入术后心血管事件的关系

目的探讨血清高敏C-反应蛋白(hs-CRP)水平与冠心病患者病变程度及冠脉支架植入后心血管事件的关系。方法选择139例冠状动脉支架植入的冠心病患者,其中稳定型心绞痛组44例,急性冠脉综合征组95例,术前测定血清hs-CRP水平并按hs-CRP水平分为两组,A组(hs-CRP<3.0 mg/L)55例,B组(hs-CRP≥3.0 mg/L)84例,比较分析患者冠脉病变程度及术后1年内的心血管事件。结果急性冠脉综合征组术前血清hs-CRP水平较稳定型心绞痛组明显升高(P<0.01);B组患者病变程度较A组严重(P<0.01),术后1年内的心血管事件发生率显著高于A组(P<0.01)。结论血清hs-CRP水平与冠脉病变程度相关,且是冠脉病变支架植入术后1年内预后的预测指标,提示冠脉病变程度及术后1年内心血管事件发生率与血管壁的炎症反应相关。     

纤维蛋白原、D-二聚体及GRACE评分评估急性冠脉综合征患者病情分析

目的探讨纤维蛋白原、D-二聚体及全球急性冠状动脉事件注册(GRACE)评分评估急性冠脉综合征患者病情的价值。方法选取30例健康人群作为对照组,选取急性冠脉综合征患者120例作为观察组,对患者进行GRACE评分并给予低危、中危、高危危险度分层,并对不同对象的纤维蛋白原、D-二聚体水平进行检测分析。结果对照组的纤维蛋白原、D-二聚体水平明显低于观察组,差异均有统计学意义(P0.05)。急性冠脉综合征患者中,低危、中危、高危患者的纤维蛋白原、D-二聚体水平比较差异有统计学意义(P0.05),表现为纤维蛋白原水平低危组中危组高危组,D-二聚体水平低危组中危组高危组。结论急性冠状动脉综合征患者的纤维蛋白原、D-二聚体水平与其GRACE评分具有一定的关联性;而纤维蛋白原、D-二聚体水平能在一定程度上替代GRACE评分,较为简便、快速、准确地评估患者病情的严重程度、指导治疗。     

Firebird支架治疗冠心病140例临床观察

观察国产Firebird支架在冠心病患者介入治疗中的临床疗效。方法共140例冠心病患者常规冠状动脉造影后行经皮冠状动脉介入(PCI)治疗,其中64例患者植入Firebird支架,76例患者置入普通支架,术前术后除常规使用阿司匹林和波立维外,同时给予严格的内科强化治疗,术后进行随访。结果冠状动脉造影显示2支以上血管病变占70.56%,一共植入Firebird支架114枚,普通支架105枚,所有患者均获得成功。平均随访(10.2±3.3)个月,其中药物支架组复发心绞痛18例,10例发生心肌梗死;普通组复发心绞痛40例,16例发生心肌梗死。部分患者行冠脉造影复查,Firebird支架组发生再狭窄2例,普通支架组发生再狭窄8例,均进行了靶病变重建术。结论Firebird支架对冠心病患者近期疗效确切,能减少再狭窄的发生。     

强化瑞舒伐他汀治疗对急性冠脉综合征患者PCI术后hsCRP的影响

目的:观察强化瑞舒伐他汀治疗对急性冠脉综合征患者经皮冠状动脉介入治疗(PCI)术后不同时间点高敏C反应蛋白(hsCRP)的影响。方法:选择2011年7月~2012年6月在我院诊断为急性冠脉综合征患者86例,随机分为2组。强化组于PCI术前服用瑞舒伐他汀20 mg/d,术后持续1周,1周后减量为10 mg/d。对照组PCI术前术后均为10 mg/d。分别于术前、术后1 d、术后1周,术后1个月检测患者血浆中hsCRP的变化。结果:强化组患者PCI术后1 d、术后1周血浆hsCRP的水平明显低于对照组,而PCI术后1个月两组患者血浆hsCRP的水平无显著差异。结论:PCI术前及术后1周应用瑞舒伐他汀20 mg/d较10 mg/d能够明显降低血浆hsCRP水平,且安全性良好。     

药物涂层支架与金属裸支架对稳定型心绞痛患者局部冠状动脉循环组织因子水平早期影响的比较

目的比较药物涂层支架（DES）与金属裸支架（BMS）置入前后冠状动脉循环内局部血浆组织因子（TF）水平的变化,探讨DES对血浆TF水平的早期改变及其对急性支架内血栓（AST）形成的意义。方法入选稳定型心绞痛患者26例,按标准方法行冠状动脉造影证实有冠状动脉狭窄均在70%以上。其中15例置入DES（DES组）,11例置入BMS（BMS组）。全部患者术前给予阿司匹林、氯吡格雷口服,支架置入前静脉给予低分子质量肝素。PCI术中冠状动脉内血样采集顺序依次为：支架置入前后冠状动脉入口处（ostium）用引导导管,支架置入后15 min通过血栓吸引器穿过病灶在病灶下方（beyond the lesion）采血。血浆TF水平检测采用酶联免疫双抗体夹心法（ELISA）。结果PCI术前26例患者在冠状动脉入口处与病灶下方冠状动脉循环内的TF基线水平比较差异无统计学意义（31.50±7.05 ng/L比31.40±7.30 ng/L,P=0.748）,但高于正常参考值3倍;支架置入后15min在冠状动脉入口处（29.60±6.96 ng/L比31.50±7.05 ng/L,P=0.135）与病灶下方（30.70±7.70 ng/L比31.40±6.30 ng/L,P=0.230）冠状动脉循环内的TF水平与术前比较,差异亦无统计学意义。术后15min,DES组和BMS组冠状动脉入口处（31.20±4.37 ng/L比30.70±5.39 ng/L,P=0.674）及病灶下方（31.60±5.39 ng/L比29.00±7.96 ng/L,P=0.789）TF水平差异均无统计学意义。结论稳定型心绞痛患者冠状动脉循环血内存在大量的TF。DES和BMS两种支架均不引起冠状动脉内局部、早期血浆TF水平的改变。     

急性冠脉综合征患者药物洗脱支架雷帕霉素CypherTM植入后的不良反应分析

目的:分析雷帕霉素药物洗脱支架CypherTM植入后对急性冠脉综合征患者近、远期的不良反应.方法: 选择接受CypherTM治疗的冠心病患者83例,在支架植入术后9个月内全部接受门诊随访及冠脉造影,了解支架内急性和亚急性血栓、边缘效应、贴壁不良现象、支架处动脉瘤发生率及相应的不良心脏事件(MACE)发生情况.结果:83例患者共植入支架112个,植入成功率为98.8%(82/83).29例(34.9%)接受冠脉造影,MACE9例,发生率10.8%(9/83),其中,1例术中发生猝死,1例术后3d因亚急性血栓造成再发心肌梗死,其余7例在出院后1～3 月内发生心绞痛,皆经造影证实为血栓形成,再次成功靶血管血运重建8例;其余20例无症状患者造影发现支架边缘狭窄(无血栓)2例,总再狭窄为13.3%(11/83);无动脉瘤发生.9例MACE中,有弥漫病变5例,其中4例植入长支架,1例植入重叠支架,其余为简单病变;29例患者共发现贴壁不良现象5例,皆发生MACE,其中4例为弥漫病变植入长支架,1例为简单病变.结论:急性或亚急性血栓形成是药物支架CypheTM植入后出现的主要不良反应,可能与弥漫病变植入长、重叠支架引起贴壁不良有关.     

急性心肌梗死患者血清肿瘤坏死因子变化及其对预后的影响

目的 探讨急性心肌梗死(AMI)患者血清肿瘤坏死因子(TNF-α)水平的变化,进一步判断其对AMI患者预后的影响.方法 行择期经皮冠状动脉介入治疗(PCI术)的急性ST段抬高型心肌梗死患者65例(所有入选患者梗死相关动脉未再通),根据PCI术前1天血清TNF-α水平分为正常TNF-α组(N组)30例和高TNF-α组(H...     

雷帕霉素洗脱支架在急性冠状动脉综合征中的应用

目的 观察雷帕霉素洗脱支架(CypherTM)对急性冠状动脉综合征(acute coronary syndrome,ACS)的疗效.方法 选择住院的接受雷帕霉素洗脱支架植入的ACS 83例,在支架植入术后9个月内,进行电话或门诊随访,冠状动脉造影或冠状动脉螺旋CT扫描,计算不良心脏事件发生率,评价合并糖尿病及其它病变的疗效.结果 83例患者共植入支架112枚,植入成功率为98.8%.接受冠状动脉造影29例(34.9%),接受冠状动脉螺旋计算机断层扫描1例.发生主要不良心脏事件10例,发生率12.0%,其中猝死1例,再发心肌梗死1例,再次血运重建8例(1例为新的病变),与支架相关的再狭窄及血栓事件发生率为10.8%(9/83);糖尿病、弥漫病变、重叠支架、高血脂时再狭窄率分别为13.3%,11.1%,11.1%和8.5%.结论 雷帕霉素洗脱支架治疗ACS安全、可靠;弯曲、弥漫、较长的冠状动脉病变或合并糖尿病者,出现再狭窄的概率增加.     

氧化低密度脂蛋白、高敏C反应蛋白与冠状动脉支架置入术后再狭窄的关系

目的:探讨氧化低密度脂蛋白(ox-LDL)、高敏C反应蛋白(hs-CRP)与经皮冠状动脉介入治疗(PCI)术后支架内再狭窄的相关性。方法:45例患者PCI术后6~12个月内接受冠状动脉造影复查,其中18例有再狭窄作为再狭窄组,27例无再狭窄作为对照组。2组术后均接受阿司匹林、波立维、他汀类等药物治疗。取2组患者PCI术前、后冠状动脉造影复查时血浆标本,采用酶联免疫吸附法(ELISA)检测血浆ox-LDL水平,超敏免疫比浊法检测血浆hs-CRP水平,酶法测定血脂水平。结果:①再狭窄组PCI术后ox-LDL、hs-CRP水平较术前均明显升高[(1.32±0.35)∶(0.53±0.17)mg/L、(4.82±1.44)∶(3.50±1.18)mg/L],均P0.01;对照组PCI后ox-LDL、hs-CRP水平较术前明显下降[(0.32±0.13)∶(0.55±0.13)mg/L、(2.28±0.71)∶(3.37±1.25)mg/L],均P0.05。②再狭窄组和对照组PCI术前ox-LDL、hs-CRP水平差异无统计学意义,再狭窄组PCI术后ox-LDL、hs-CRP水平显著高于对照组(均P0.01)。③再狭窄组和对照组术后TC、TG、LDL-C水平均较术前明显下降(P0.05),但2组间PCI术前和术后比较均差异无统计学意义(P0.05)。④再狭窄组和对照组术前、术后ox-LDL和hs-CRP水平均呈正相关。结论:PCI术后再狭窄患者血浆ox-LDL及CRP水平明显升高,二者可作为PCI术后再狭窄的预测指标。     

门控核素心肌灌注显像判断冠状动脉支架再狭窄的价值

目的:探讨门控核素心肌灌注显像(G-MPI)对冠状动脉(冠脉)支架再狭窄的诊断价值.方法:65例冠脉支架术后3个月以上的患者行两日法负荷/静息99Tcm-甲氧基异丁基异腈(MIBI) G-MPI,所有患者的G-MPI与冠脉造影(CAG)均在同期的1个月内完成,其中先做CAG检查的患者未进行再次血运重建术.以CAG为标准,分析G-MPI诊断冠脉支架再狭窄的价值.结果:65例患者的88支冠脉共置入105枚支架,随访CAG发现38.5%(25/65)的患者出现支架再狭窄,发生再狭窄的支架数为29.5%(31/105);根据典型症状诊断支架再狭窄的敏感性、特异性和准确性分别为64.0%、22.5%、38.5%;心电图运动平板试验(ETT)诊断支架再狭窄的敏感性、特异性、准确性分别为41.2%、71.9%、61.2%;G-MPI诊断支架再狭窄的敏感性、特异性、准确性分别为92.9%、86.7%、88 6%,其准确性明显优于ETT(χ2=14.173,P<0.001)和症状(χ2=42.781,P<0.001).结论:G-MPI诊断冠脉支架术后再狭窄具有良好的价值.     

Increased C-reactive protein level after coronary stent implantation in patients with stable coronary artery disease

Background Elevation of C-reactive protein (CRP), among other markers of inflammation, is associated with an increased risk for cardiac events in patients with known coronary diseases and in apparently healthy individuals. Moreover, in patients with acute coronary syndromes, elevated serum levels of CRP are strongly predictive of the risk for death from cardiac causes. The purpose of this study was to investigate whether mechanical rupture of an atherosclerotic coronary plaque during elective stent implantation in patients with stable coronary artery disease (CAD) at low risk will cause a significant increase in serum levels of CRP. Methods and Results We measured serum CRP levels in 40 patients. Group 1 consisted of 12 consecutive patients with stable coronary disease who were at low risk, before and after elective coronary stent implantation. We compared the results in these patients to those of patients in 2 control groups: group 2 consisted of 12 consecutive patients with non-ST-segment elevation acute coronary syndrome (NSTSE ACS) who were undergoing coronary stent implantation, and group 3 included 16 consecutive patients with stable or unstable CAD who were undergoing diagnostic coronary angiography only without PCI. Peripheral blood samples for CRP level testing were withdrawn before percutaneous coronary intervention or angiography at the completion of the procedure, and 6, 20, and 48 hours thereafter. All patients with stable CAD (group 1) had a significant and uniform increase in serum CRP levels after elective stent implantation. The low mean baseline serum CRP levels increased 4.9 ± 4.1-fold 20 hours after coronary intervention (2.1 ± 1.2 before, 7.9 ± 3.4 after, P < .002). The baseline CRP level was much higher in the patients with unstable coronary syndromes (group 2). In this group, only a 2.1-fold increase in mean CRP level was observed after stent implantation (7.4 ± 5.5 before, 14.1 ± 9.6 after, P < .004). Also, the response in this group was less uniform when compared with that in the stable CAD group. By contrast, in patients undergoing diagnostic coronary angiography, the mean baseline CRP level was higher than in the patients in the group with stable CAD; however, the mean CRP after the procedure was not significantly elevated in this group (4.5 ± 3.6 before, 5.5 ± 3.7 20 hours after, P = not significant). Conclusions Mechanical disruption of an atherosclerotic coronary plaque during elective coronary stent implantation in patients with stable CAD who are at low risk causes a systemic inflammatory response expressed by marked elevation in CRP concentration. (Am Heart J 2003;145:248-53.)     

Direct coronary stent implantation: safety, feasibility, and predictors of success of the strategy of direct coronary stent implantation.

This prospective study was designed to evaluate the feasibility, safety, predictive factors of success, and 6-month follow-up of stent implantation without balloon predilatation (direct stenting) in 250 patients undergoing elective stent implantation. Balloon dilatation prior to stent implantation was a prerequisite to facilitate passage and deployment of the stent. Stent technology has changed tremendously, resulting in stents with improved properties, which may allow stent placement without prior balloon dilatation. Patients with coronary lesions suitable for elective stent implantation were included in this trial. Coronary interventions were undertaken predominantly via the transradial route using 6 Fr guiding catheters. Direct stent implantation was attempted using AVE GFX II coronary stent delivery systems. Upon failure, predilatation was undertaken before reattempting stent implantation. Patient data and ECGs were obtained from case records and from personal or telephone interviews 6 months after the procedure. Values were presented as mean +/- standard deviation. Student's t-test, two-tailed at 5% level of significance, was used to compare the difference of two means. Multivariate logistic regression analysis was performed to establish predictive factors for failure of direct stenting. Two hundred and sixty-six direct stent implantations were attempted in 250 patients. Direct stenting was successful in 226 (85%) cases. Out of 40(15%) cases where direct stenting failed, balloon predilatation facilitated stent implantation in 39. In one lesion, stent implantation was not possible despite adequate predilatation. Predictive factors for failure of direct stenting on multivariate analysis were LCx lesions (P < 0.01), complex lesions (P < 0.01), and longer stents (P < 0.001). Minimal luminal diameter and percentage diameter stenosis of lesions in the successful and the failure group were not significantly different (0.94 +/- 0.39 mm vs. 0.84 +/- 0.41 mm, P = NS, and 70.2 +/- 11.2 vs. 73.2 +/- 11.2, P = NS). Stent loss occurred in five (2.0%) cases, with successful retrieval in four. One stent was lost permanently in a small branch of the radial artery. Post-percutaneous coronary intervention (post-PCI) myocardial infarction occurred in four (1.6%) patients. There were no other in-hospital events. Six-month-follow up information was obtained in 99% of patients. Subacute stent thrombosis was noted in four (1.6%) cases. Target vessel-related myocardial infarction rate was 3.2%, of which half was caused by subacute stent thrombosis. The overall reintervention rate (coronary artery bypass grafting or PCI) was 9.7%. Target lesion revascularization by PCI occurred in only 4.0%. At 6 months, overall mortality was 2.0%, of which 1.2% was due to coronary events. Direct stent implantation is safe and feasible in the majority of cases with low rate of complications. Unfavorable factors include circumflex lesion, more complex lesion morphology, and increasing length of stent. Severity of stenosis does not appear to be of predictive value. Long-term outcome is favorable with a low target lesion revascularization rate.     

The new Polish stent Chopin. Assessment of safety and efficacy in the treatment of de-novo coronary lesions using percutaneous angioplasty

AIM: The aim of the present study was to assess the safety and efficacy of percutaneous coronary interventions (PCI) using the new Polish stent "Chopin" (Balton, Poland). METHODS: The study consisted of experimental and clinical parts. In the experimental phase, the new stent was implanted into 5 pigs and control coronary angiography as well as intracoronary ultrasonography (ICUS) were performed 30 days later. In the clinical phase, 101 patients (57% of males, mean age 55.6+/-10 years) with symptomatic coronary artery disease (CAD) with "de novo" coronary lesions (including 12% of patients with unstable angina and 19% with acute myocardial infarction [MI]) underwent stent implantation. The patients were followed for 6 months for the occurrence of cardiac events. Quantitative coronary angiography was performed at baseline and after 6 months. RESULTS: In total, we attempted to implant 107 stents, which resulted in the successful deployment of 106 stents to 105 coronary arteries. The mean diameter of the stents was 3.2+/-0.3 mm, and length - 15.4+/-2 mm. During a one month follow-up period no cardiac events were noted. During a 6-month follow-up no death or new MI were recorded. Repeated target vessel revascularisation due to recurrent angina and in-stent restenosis was required in 15 (15.5%) patients. Control coronary angiography was performed in 97 (96%) patients. Of 101 stents, angiographic restenosis (narrowing of dilated lesion by >50% of vessel lumen) was documented in 18.8% of cases. The mean late vessel lumen loss was 0.77+/-0.6 mm, and stenosis - 29.1+/-20%. The restenosis rate was significantly higher in patients with unstable angina rather than in those with stable angina or acute MI. CONCLUSIONS: Implantation of the new Polish stent "Chopin" during PCI is safe and effective.