A single center investigation of bare-metal or drug-eluting stent restenosis from 1633 consecutive Chinese Han ethnic patients

Background Stents are widely used in China but the clinical impression is somehow that restenosis is less common because of the lower prevalence of coronary artery disease (CAD) and associated risk factors in Chinese populations. However, no large-sample published studies are available on angiographic stent restenosis including those of bare-metal stent (BMS) or drug-eluting stent (DES) in Chinese Han ethnic population.Mothods A total of 1633 consecutive patients with CAD who had undergone coronary stenting, quantitative coronary angiography (QCA) were retrospectively studied. At the time of stent implantation and at 7 months post-stenting 675 patients had a follow-up angiography. Statistical analysis was made with the chi-square test for categorical variables, unpaired t test for continuous variables, univariate or multivariate regression for baseline and angiographic characteristics and the Kaplan-Meier method for rate of target lesion revascularization (TLR).Results Stent restenosis was defined as ≥50% diameter stenosis in the dilated segment. A total of 675 patients with 1074 lesions were subjected to angiographic follow-up for 7 months on average. Of these lesions, 448 were implanted with BMS whereas 626 lesions with DES. At 7 months, bare-metal in-stent restenosis occured in 148 lesions (33.0%), and bare metal in-segment restenosis in 155 lesions (34.6%) in contrast to drug-eluting in-stent restenosis in 48 lesions (7.7%) and drug-eluting in-segment restenosis in 73 lesions (11.7%) (P<0.001 compared with BMS respectively). Late loss in both in-stent and in segment was higher in BMS than in DES groups [(1.00±0.69) vs (0.28±0.52); (0.78±0.71) vs (0.21±0.52), P<0.001 respectively]. Angulated lesion, lesion length, pre-procedural minimal luminal diameter (MLD), and BMS were independent predictors for TLR, (P<0.01 respectively), whereas current smoker, ostial lesion, and stent overlapping, post-procedure in-stent MLD, lesion length, and stent types were independent predictors for in-segment restenosis (P<0.01 respectively). Standard coronary risk factors such as hypertension, hyperlipidemia, diabetes, and history of CAD were not associated with a higher rate of restenosis caused by BMS or DES implantation in our Chinese Han ethnic population.Conclusions Coronary stenting including BMS or DES implantation in Chinese Han ethnic patients is associated with a restenosis rate comparable to that demonstrated in previous studies from the western countries, and predictors of stent restenosis are somehow different from those in the western population.     

Mechanisms and clinical significance of quality of final kissing balloon inflation in patients with true bifurcation lesions treated by crush stenting technique

Background The mechanisms responsible for the occurrence of a kissing unsatisfied （KUS） result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS. Methods Two hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation （FKBI） were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis （QCA） and intravascular ultrasound （IVUS）. Angiographic follow-up was indexed at 12 months. Results The upper group was characterized by a larger bifurcation angle of 55.53°±25.25° （P=0,030） and a longer procedural time （42.43±23.92） minutes （P=0.015）. The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group （P 〈0.001）. For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS （HR 1.652, 95% Cl 1.332-2.088, P 〈0.001） and re-wiring position （HR 2.341, 95% Cl 1.780-4.329, P 〈0.001） were two independent predictors of side branch restenosis. Re-wiring position （OR 0.458, 95%C/0.336-0.874, P=0.001） and side stent expansion （OR 3.122, 95%C/2.883-5.061, P=0.014） were factors predicting the findings of KUS. Conclusions Side wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.     

DK crush technique: modified treatment of bifurcation lesions in coronary artery

Bifurcation lesions are still technically challenging even in the era of modern stents.1 High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations.2-5 Reports have demonstrated the main reason for higher incidence of ostial side branch even though drug-eluting stent used in side vessel lies in that there were gaps in metal coverage and drug application.6-9 Therefore, new technique ensuring complete vessel scaffolding without gaps in drug delivery at the bifurcation is crush technique which is similar to other techniques including T- and Y- stenting still needing postdilatation of kissing balloon angioplasty to expand the stent fully in the ostial side branch and to prevent stent distortion in main vessel.10 As a result, kissing balloon angioplasty is a key step to improve the final result and to reduce the restenosis after stenting bifurcation lesions. However, kissing angioplasty is difficult to be underwent or impossible because operators usually fail to rewire two layers of metal strut, which would result in suboptimal stent deployment, a main reason of high incidence of restenosis, and acute- or-late-thrombosus. The present study reports modified DK crush technique improving success rate of kissing balloon angioplasty under the guidance of intravascular ultrasound (IVUS).     

Technical refinement for treatment of coronary bifurcation lesion is still demanding

Bifurcation lesions, one of the complex coronary lesion subsets, are usually encountered in around 15%-25% of patients during percutenous coronary intervention （PCI）. The treatment of stenoses at a bifurcation poses an ongoing challenge for the interventional cardiologists1-3 as PCI for bifurcation lesions is associated with the reduced procedural success rate and increased angiographic restenosis, especially in the side branch, or even portends a potentially negative impact on long-term clinical outcomes.4,5 The use of drug-eluting stents is generally recommended during bifurcation lesion intervention as it could result in a lower rate of main vessel restenosis. However, side branch ostial residual stenosis and stent thrombosis remain worrisome.6,7     

Comparison of short- and mid-term outcomes between CYPHER and TAXUS stents in patients with complex lesions of the coronary arteries

Background Drug-eluting stent （DES） could obviously reduce in-stent restenosis, which has been proved by international multi-center clinical trials. However, the types of the lesions for stenting were highly selected in these trials. Up to now, there has been no large scale study on the effect of DES in treating complex lesions in real world. Although REALITY trial was just reported during American College of Cardiology Congress 2005, the entry criteria for lesions were limited to one or two de novo lesions. This study was conducted to compare the short- and mid-term clinical outcomes between sirolimus-eluting stent （CYPHER stent） and paclitaxel-eluting stent （TAXUS stent） in patients with complex lesion. Methods This is a retrospective study. From April 2002 to June 2004, a total of 1061 patients were treated with DES in Fu Wai Hospital, of which, 611 patients （642 lesions with 698 CYPHER stents） were in CYPHER group, and 450 patients （534 lesions with 600 TAXUS stents） were in TAXUS group. There was no significant difference in clinical data and lesion types between CYPHER group and TAXUS group. Results Success rates of stent implantation were 99.2% and 98.8% in CYPHER and TAXUS stent groups respectively. The major adverse cardiac events （MACE） during in-hospital and 6-8-month follow-up were 0.7% and 2.3% in CYPHER stent group versus 1.3% and 3.2% in TAXUS stent group. There was no significant difference in MACE rate between these two groups. Restenosis rate was a little higher in TAXUS stent group than that in CYPHER stent group （14.0% vs 7.3%）, but there was no significant difference. The incidence of acute occlusion of side branch after implanting DES in main vessel was 6.9% in CYPHER group and 11.9% in TAXUS group （P〈0.05） . Conclusions CYPHER and TAXUS DES were safe and effective in patients with complex lesion. Clinical outcomes of CYPHER stent were better than TAXUS stent in bifurcation lesions. There was an increasing tendency in restenosis rate and late thrombosis in TAXUS group as compared with that of CYPHER group.     

Long-term outcomes following drug-eluting stent implantation in unprotected left main bifurcation lesions

Background The safety and efficacy of drug-eluting stents （DES） implantation in unprotected left main （LM） bifurcation lesions has yet to be determined. The aim of the present report was to evaluate the long-term outcome following implantation of DES in unprotected LM bifurcation lesions. Methods We identified 70 consecutive patients treated with DES in unprotected LM bifurcation lesions from April 2003 to January 2005. Of them, 42 patients were treated with sirolimus-eluting stent （SES） and 28 patients were treated with paclitaxel-eluting stent （PES）. Results Stents to the left anterior descending and to the circumflex were implanted in 62 patients. During 1-year follow-up, 3 （4.3%） patients died of cardiac causes. One of them had myocardial infarction and adjudicated as possibly due to stent thrombosis. Angiographic follow-up was available in 80% of patients. The per lesion restenosis rate was 13.4% in the entire cohort, of which 10.7% occurred in lesions treated with SES and 16.1% in those treated with PES （P=0.58）. All restenosis was focal and occurred in the lesions treated with a stent with stent size to post-procedural reference vessel diameter ratio 〈1.0 （17.6% vs 0, P=0.04）. The per patient target lesion revascularization rate at 1 year was 17.1%. One year survival free from major adverse cardiac events was 77.1%. Conclusions Treatment of LM bifurcation lesions using DES is a safe and feasible way with a low one-year mortality. The need for revascularization in 17% of patients demands for improvement.     

Novel side branch ostial stent （BIGUARD^TM）： first-in-man study

Background Stenting a bifurcation lesion is technically challenging. No study has reported the clinical outcome of a dedicated bifurcation stent in China. We aimed to analyze the safety and clinical outcome of a novel side branch ostial stent （BIGUARDTM） stent in treating coronary bifurcation lesions. Methods Forty-seven patients were enrolled in this first-in-man study, with 61.7% true bifurcation lesions （0,1,1 and 1,1,1） and 26.7% diabetes. A two-stent technique was used in 27.6% of the patients, and 64.7% of patients crossed from the one-stent technique to the two-stent arm. Clinical and angiographic follow-up data at 12 months were available in all the 47 patients and in 43 patients （91.9%）, respectively. The study endpoint was the occurrence of major adverse cardiac events （MACE） at 12 months. Results Only one patient had a non-ST segment elevation myocardial infarction, which led to 2% of the in-hospital composite MACE. Notably, the target lesion revascularization at 12 months was 8.6%, with a 10.6% composite MACE at 12 months. Neither cardiac death nor stent thrombosis was seen during the follow-up. By quantitative coronary analysis, the restenosis rate at the main vessel and ostium of the side branch was 9.4% and 2.1%, respectively. Four of 12 patients （33.3%） treated with one-stent and kissing balloon inflation had restenosis in the main vessel. Conclusion BIGUARDTM stent was safe and feasible in treatment of bifurcation lesions.     

Long-term efficacy and safety of drug-eluting stent implantation for patients with multiple coronary chronic total occlusions

Background Data on the efficacy and safety of drug-eluting stent （DES） for treatment of multiple coronary chronic total occlusion （CTO） lesions are scanty. The aim of the present study was to compare the long-term outcomes of DES versus bare metal stent （BMS） implantation for multiple coronary CTO lesions.Methods We analyzed 188 patients who underwent coronary stenting for at least two de novo CTO lesions in our center from November 2000 to November 2006. Among them, 118 patients （62.8%） received DES and 70 patients （37.2%） received BMS implantation after the recanalization for CTO lesions. All patients were followed up for up to 5 years for the occurrence of major adverse cardiac events （MACE）. Long-term survival rates were estimated with the Kaplan-Meier method.Results There were no significant differences in baseline clinical characteristics and procedural success rate between DES group and BMS group. Compared with the BMS group, the DES group showed a significantly higher rate of long CTO （≥15 mm） （62.0% vs. 50.6%, P=0.023）. The number of stents per lesion （1.39±0.71 vs. 1.17±0.66, P=0.007） and the mean length of stents in the DES group were also higher than those in the BMS group （（40.8±11.4） mm vs. （23.4±8.7） mm, P〈0.001）. But the mean diameter of stents in the DES group was smaller than that in the BMS group （（3.1 ±0.2） mm vs. （3.3±0.5） mm, P〈0.001）. Average follow-up time was 4.8±0.7 （1.5-5.0） years in the BMS group and 4.3±0.5 （1.3-5.0） years in the DES group. Both the 5-year cumulative survival rates and the target vessel revascularization （TVR）-free survival rates of the DES group were significantly higher than those in the BMS group （83.1% vs. 72.9%, Log-rank P=0.044; 77.1% vs. 62.9%, Log-rank P=0.009）. The cumulative MACE-free survival rates in the DES group were significantly higher than those in the BMS group （71.2% vs. 51.4%, Log-rank P=0.001）. Multivariable Cox regression analysis demonstrated that DES implantation for multiple CTO lesions could significantly reduce the long-term MACE risk after percutaneous coronary intervention （PCI） （HR. 0.436; 95%C/ 0.327-0.665, P 〈0.001）. Age over 65 years （HR. 2.018; 95%CI1.491-3.127, P〈0.001） and left ventricular ejection fraction 〈50% （HR. 1.494; 95%CI1.125-2.376, P 〈0.001） were identified as the independent predictors of long-term MACE.Conclusion This study demonstrates the long-term （up to 5 years） efficacy and safety of DES for treatment of multiple coronary CTO lesions, and its superiority compared to BMS in reducing the rates of TVR and MACE.     

Volumetric intravascular ultrasound comparisons of drug-eluting stent thrombosis and in-stent restenosis

Objectives We compared intravascular ultrasound (IVUS) findings of drug-eluting stent (DES)-treated lesions that developed stent thrombosis versus in-stent restenosis (ISR) to identify underlying mechanical differences. Methods IVUS findings in 15 post-DES thrombosis patients were compared with 45 matched ISR patients who had no evidence of stent thrombosis. Results Minimum stent area [MSA, (3.7±0.8) mm2 vs (4.9±1.8) mm2, P=0.01], minimum stent diameter [(1.9±0.3) mm vs (2.3±0.4) mm, P=0.005], mean stent area [(5.2±0.8) mm2 vs (7.2±2.1) mm2, P<0.01], and both focal [MSA/reference lumen area, (54.7±15.9)% vs (75.0±20.1)%, P=0.001] and diffuse stent expansion [mean stent area/reference lumen area, (76.6±23.0)% vs (110.3±23.3)%, P<0.01] were significantly smaller in the stent thrombosis group (vs the ISR group). An MSA <4.0 mm2 (73.3% vs 35.6%, P=0.01) or <5.0 mm2 (86.7% vs 53.3%, P=0.02) was more often found in the stent thrombosis group (vs the ISR group). The MSA site occurred more frequently in the proximal stent segment within the stent thrombosis group compared to the ISR group (60% vs 24.4%, P=0.01). There were no differences in edge dissection, stent fracture, or stent-vessel wall malapposition between the two groups. Independent predictors of stent thrombosis were diffuse stent expansion (OR=1.5, P=0.03) and proximal location of the MSA site (OR=12.7, P=0.04). Conclusion DES-treated lesions that develop thrombosis or restenosis are often underexpanded. Underexpansion appears to be more severe in DES-thrombosis lesions. Lesions with diffuse underexpansion and a proximal (vs distal) underexpanded MSA site are more predisposed to thrombus formation than ISR.     

Effect of coronary bifurcation angle on clinical outcomes in Chinese patients treated with crush stenting: a subgroup analysis from DKCRUSH-1 bifurcation study

Background Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high （≥60°） with low （〈60°） bifurcation angle in patients who underwent either classical or double kissing （DK） crush stenting for bifurcation lesions from the DKCRUSH-1 data base.
Methods There were 212 patients with 220 lesions, some with low-angle （n=138） and some with high-angle （n=74）. Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events （MACEs）, defined as cardiac death, myocardial infarction and target lesion revascularization （TLR）. Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation （FKBI）.
Results At 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group （91.43%） and the low-angle group （82.39%）. In the high angle group, there was a significant difference in contrast volume used （P=0.005） but no significant difference in acute gain, minimum lumen diameter （MLD）, late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with- （n=-133） and without-FKBI （n=42）, significant side-branch late loss was seen in the group without-FKBI （（0.65±0.49） mm vs （0.47±0.62） mm, P=0.02）, with a resultant greater restenosis rate （37.68% vs 18.32%, P=0.001）. No difference was detected in the MACE free survival rate between the high and low angle groups （82.39% vs 82.36%, P=0.84）. The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference （P=0.38）. The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group （P=0.001）. Cox regression analysis showed that the independent predictors for target vessel revascularization were the side branch stent MLD post stenting （hazard ratios （HR） 1.028, 95% CI 2.357-16.233, P=0.002）, lack of FKBI （HR 4.910, 95% CI 4.706-8.459, P=0.001） and unsatisfactory kissing （HR 3.120, 95% CI2.975-5.431, P=0.001）.
Conclusions Bifurcation angles do not influence the clinical outcome of crush stenting. Successful final kissing balloon inflation, regardless of bifurcation angles, can predict TLR.     

冠状动脉药物支架再狭窄形式分析

目的:分析冠状动脉支架置入后造影复查的影像资料,寻找不同药物支架再狭窄的特点。方法:收集冠状动脉介入治疗后造影复查再狭窄患者121例,共159处病变,进行再狭窄形式分析。结果:裸支架(BMS)和药物支架(DES)后再狭窄病变局限性再狭窄分别占39.80%和70.49%(P<0.001);弥漫性再狭窄病变分别占60.20%和29.51%(P<0.001);三种不同类型DES(Cypher,Taxus和Firebird)再狭窄形式没有差异,局限性再狭窄分别为83.33%,55.56%和75.00%(P=0.070);弥漫性再狭窄分别占16.67%,44.44%和25.00%,(P=0.070)。结论:①DES改变了以往BMS再狭窄模式,由弥漫型转为局限型;②不同种类的药物支架再狭窄形式没有差异。     

Sirolimus-eluting stents for treatment of drug-eluting versus bare-metal stents restenosis: 42-month clinical outcomes from a Chinese single center

Background  Restenosis of bare-metal stents (BMS) and drug-eluting stents (DES) has been increasingly treated with sirolimus-eluting stents (SES), but the long-term outcomes are unknown.

Methods  In our study, 388 consecutive patients (144 DES restenosis and 244 BMS restenosis) with 400 lesions (147 DES restenosis and 253 BMS restenosis) treated with SES were included. The rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) at 42 months were analyzed.

Results  At the mean follow-up of 42 months, the rates of death (3.5% vs. 3.3%, P=1.000) and myocardial infarction (2.8% vs. 1.2%, P=0.431) in the DES group and BMS group were comparable. Compared with the BMS group, ischemia-driven TLR occurred with a higher frequency in the DES group (18.8% vs.10.7%, P=0.024). This translated into an increased rate of MACE in the DES group (22.2% vs. 14.0%, P=0.034). Stent thrombosis occurred with a similar frequency in both groups (2.8% vs. 1.6%, P=0.475). Multivariate analysis showed that DES restenosis (OR=1.907, 95% CI 1.108–3.285, P=0.020) and smoking (OR=2.069; 95% CI 1.188–3.605; P=0.010) were independent predictors of MACE.

Conclusions  Although SES implantation appears to be safe and effective, it was associated with higher TLR recurrence for DES than BMS restenosis.

     

Drug-eluting stent for the treatment of small coronary lesion: comparison between sirolimus- and paclitaxel-eluting stent

Background  Patients with small coronary lesions are at increased risk for repeat interventions after coronary angioplasty and stenting. The efficacy of drug-eluting stents (DES) has been demonstrated to improve the outcomes of these patients and is a focus of interest. Currently, two platforms of DES are available (sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES)). However, it has less been known that DES, SES vs PES, is superior for the treatment of small coronary lesions.
Methods  In this retrospective study, 87 consecutive patients with 151 lesions underwent implantation of coronary SES (n=68) and PES (n=83). Quantitative coronary angiography (QCA) was performed at the time of stent implantation and subsequently at 8 months post-stenting. Small vessel disease was defined as lesions in vessels with diameter 2.5 mm measured by QCA. Major adverse cardiac events (MACE) including death, thrombosis, nonfatal myocardial infarction and target lesion revascularization (TLR) were compared between the two groups.
Results  Baseline clinical characteristics and angiographic parameters were similar between the two groups. At clinical and angiographic follow-up, overall thrombosis rates were similar in both groups (0 vs 1.2%, P>0.05). The TLR and in-segment restenosis were not significantly different (19.1% vs 25.3%; 10.3% vs 10.8%, P=0.365 and P=0.913 respectively) between the two groups. The in-stent restenosis rate, however, was significantly higher in the PES group (4.4% vs 21.7%; P=0.002). Similarly, the late loss was significantly higher in the PES group ((0.140.38) mm vs (0.490.61) mm; P<0.001).
Conclusions  In this small sample-size, non-randomized study, the data indicated that implantation of SES for the treatment of patients with small coronary lesion showed more favorable results in respect of restenosis compared with PES implantation.

     

Firebird and Cypher sirolimus-eluting stents and bare metal stents in treatment of very long coronary lesions

Background As a kind of sirolimus-eluting stent （SES） made in China, Firebird SES is more effective than bare metal stent （BMS） and not inferior to Cypher SES for short coronary lesions in terms of reduction of restenosis and revascularization. However, Firebird SES does not show any benefits in patients with a very long coronary lesion （VLCL）. The present study was undertaken to evaluate the safety and efficacy of Firebird SES for VLCL by comparison of Cypher SES and BMS. Methods In this prospective, nonrandomized and comparative study, eligible patients with de novo coronary lesion （≥ 30 mm） between January 2005 and June 2006 were allocated into Firebird SES group, Cypher SES group or BMS group. They were subjected to an angiographic follow-up of 6 months and a clinical follow-up of 12 months. The primary endpoints constitute the in-stent and in-segment restenosis rates at 6 months. The secondary endpoint was defined as a major adverse cardiovascular event （MACE） that was a 12-month combined endpoint of all-cause deaths, reinfarction or in-stent thrombosis, and target-lesion revascularization. The 12-month in-stent thrombosis was also evaluated to address the safety of Firebird SES implantation exceptionally. Results A total of 468 patients were assessed for eligibility. Of 113 patients who were finally included according to the prior inclusion and exclusion criteria, 39 （41 lesions） were treated with Firebird SES, 37 （39 lesions） with Cypher SES, and 37 （37 lesions） with BMS. There were no significant differences in the baseline characteristics between the three groups; but there were longer lesions, more frequent use of overlapping stent in the Firebird SES group and the Cypher SES group. Angiographic follow-up showed that the rates of binary stenosis were similar between the Firebird SES group and the Cypher SES group （in-segment： 14.6% vs 12.8%, relative risk （RR）1.14, P=0.81; in-stent： 9.8% vs 10.3%, RR 0.95, P=0.94）, and significantly lower than those in the B     

Crush stenting in treating coronary bifurcate lesions: paclitaxel eluting stents versus sirolimus eluting stents

Background Because no data regarding the comparison of crush stenting with paclitaxel （PES） or sirolimus eluting stents （SES） for coronary bifurcate lesions have been reported, we compared the clinical outcomes of these two types of stents. Methods Two hundred and thirty patients with 242 bifurcate lesions were enrolled in a prospective, nonrandomized trial Primary endpoints included myocardial infarction, cardiac death and target vessel revascularization at 8 months. Results All patients were followed up clinically and 82% angiographically at 8 months. Final kissing balloon inflation was performed in 72% in the PES and 75% in the SES groups （P〉0.05）. Compared to the SES group, PES group had a higher late loss and incidence of restenosis （P=0.04） in the prebifurcation vessel segment. The postbifurcation vessel segment in the PES group had a greater late loss （（0.7±0.6） mm vs （0.3±0.4） mm, P〈0.001） and higher restenosis in the side branch （25.5% vs 15.6%, P=0.04） when compared to the SES group. There was significant difference of insegment restenosis in the entire main vessel between PES and SES groups （P=0.004）. Target lesion revascularization was more frequently seen in the PES group as compared to the SES group （P=0.01）. There was significant difference in the accumulative MACE between these two groups （P=-0.01）. The survival rate free from target lesion revascularization was significantly higher in the SES group when compared to the PES group （P〈0.001）. Conclusion SES is superior to PES in reducing restenosis and target lesion revascularization by 8-month follow-up after crush stenting for bifurcate lesions.     

Smoking control hindered by realities in China

Background Calcified coronary lesions carry the risk of suboptimal stent expansion, subsequently leading to restenosis. The effectiveness of sirolimus-eluting stents （SES） for the treatment of calcified lesion has not been fully investigated. In the present study, therefore, we evaluated the effectiveness of SES implantation for the treatment of calcified coronary lesions.Mothods A total of 333 consecutive patients with 453 lesions were enrolled in this study. They were divided into two groups according to whether the lesion treated with SES was calcified or not; no calcification group （n=-264） and calcification group （n=-189）. Lesions treated with SES were subjected to quantitative coronary angiography （QCA） immediately and 8 months following stenting. Results Baseline clinical, demographic or angiographic characteristics were well balanced in both groups. Angiographic follow-up at 8 months, the in-stent restenosis and in-segment restenosis rates were not significantly different between the two groups; instent restenosis： 3.8% vs 4.2%; P=0.081; in-segment restenosis： 8.7% vs 10.6%, P=0.503. The target lesion revascularization （TLR） was also not significantly different between the two groups; 4.9% vs 6.9%, P=0.378. In addition, the in-stent late loss was similar in both groups; （0.16±0.40） mm vs （0.17±0.33） mm, P〉0.05. Meantime, overall thrombosis rates were also similar in both groups; 1.6% vs 1.6%, P〉0.05. Conclusion Although calcified coronary lesion was hard to stent, successful percutaneous coronary intervention with SES stenting for calcified lesions was conferred by the similar favorable results that were seen when comparing non-calcified and calcified coronary lesions.     

Clinical outcomes and cost-utility after sirolimus-eluting versus bare metal stent implantation

Background Randomized studies have shown beneficial effects of drug-eluting stent （DES） in reducing the risk of repeated revascularization. Other studies have shown higher proportion of death, myocardial infarction （MI） and increased cost concerning DES. However the long term safety and effectiveness of DES have been questioned recently.Methods To compare long term clinical outcomes, health-related quality of life （HRQOL） and cost-utility after sirolimus-eluting stent （SES） and bare metal stent （BMS） implantation in angina patients in China, 1241 patients undergoing percutaneous coronary revascularization （PCl） with either SES （n=632） or BMS （n=609） were enrolled continuously in this prospective, nonrandomized, multi-center registry study.Results Totally 1570 stents were implanted for 1334 lesions. Follow-up was completed in 1205 （97.1%） patients at 12 months. Rates of MI, all causes of death were similar between the two groups. Significant differences were found at rate of cardiovascular re-hospitalization （136 （22.4%） in BMS group vs. 68 （10.8%） in SES group, P=0.001） and recurrent angina （149 （24.5%） vs. 71 （11.3%）, P=0.001）. Dramatic difference was observed when compared the baseline and 9-month HRQOL scores intra-group （P 〈0.001）. However no significant difference was found inter-group either in baseline or follow-up HRQOL. Compared with SES, the total cost in BMS was significantly lower on discharge （62 546.0 vs. 78 245.0 Yuan, P=0.001）. And follow-up expenditure was remarkably higher in the BMS group than that in the SES group （13 412.0 vs. 8 812.0 Yuan, P=0.0001）.Conclusions There were no significant differences on death, in-stent thrombosis, MI irrespective of stent type. SES was superior to BMS on improvement of life quality. SES was with higher cost-utility compared to BMS.     

A comparison of angiographic and clinical outcomes after sirolimus-eluting versus paclitaxel-eluting stents for the treatment of in-stent restenosis

Background In-stent restenosis （ISR） remains a challenge for interventional cardiologists. Some data suggest that drug-eluting stents （DES） represent a promising new option for the treatment of patients with ISR. Currently, 2 DES platforms are available [sirolimus-eluting stents （SES） and paclitaxel-eluting stents （PES） ], but the superiority of either approach for treating ISR has not been convincingly demonstrated. The aim of the present study was to retrospectively compare angiographic and clinical outcomes after treatment of ISR with SES or PES in a series of consecutive patients with ISR.