Impact of drug-eluting stent-associated coronary artery spasm on 3-year clinical outcomes: A propensity score matching analysis

BackgroundIt has been reported that significant endothelial dysfunction or clinically evident vasospasm can be associated with drug-eluting stents (DESs). However, the impact of DES associated coronary artery spasm (CAS) on long-term clinical outcomes has not been fully elucidated as compared with those of patients with vasospastic angina.MethodsA total of 2797 consecutive patients without significant coronary artery lesion (<70%), who underwent the Acetylcholine (Ach) provocation test, were enrolled between Nov 2004 and Oct 2010. DES-associated spasm was defined as significant CAS in proximal or distal to previously implanted DES site at follow-up angiography with Ach test. Patients were divided into two groups (DES-CAS; n = 108, CAS; n = 1878). For adjustment, propensity score matching (PSM) was done (C-statistics = 0.766, DES-CAS; n = 102, CAS; n = 102). SPSS 20 (Inc., Chicago, Illinois) was used to analyze this data.ResultsBaseline characteristics were worse in the DES-CAS group. After PSM, both baseline characteristics and the Ach test results were balanced except higher incidence of diffuse CAS and ECG change in the DES-CAS group. During Ach test, the incidence of diffuse spasm (93.1% vs. 81.3%, p = 0.012) and ST-T change (10.7% vs. 1.9%, p = 0.010) were higher in the DES-CAS group. At 3-year, before and after adjustment, the DES-CAS group showed a higher incidence of coronary revascularization (9.8% vs. 0.0%, p = 0.001), recurrent chest pain requiring follow up coronary angiography (CAG, 24.5% vs. 7.8%, p = 0.001) and major adverse cardiac events (MACEs, 9.8% vs. 0.9%, p < 0.005).ConclusionIn this study, DES associated CAS was associated with higher incidence of diffuse spasm, ST-T change and adverse 3-year clinical outcomes. Special caution should be exercised in this particular subset of patients.     

Long term outcomes after bare metal stent implantation

Long term outcome data after BMS implant is not available from the Indian subcontinent. This is a prospective observational study which aims to study long term outcomes after BMS implant at a tertiary care centre. 100 consecutive patients underwent BMS implant and were followed up for 20 years. LAD was the most common vessel involved and different types of BMS were implanted. All-cause mortality was noted in 21% (n = 21) whereas cardiac mortality was seen in 16% (n = 16). Cumulative revascularisation free survival at 20 years was 71%. The study showed that long term outcomes after BMS implant were fare and acceptable.     

“一站式”治疗Cockett综合征合并下肢静脉曲张临床疗效

目的评估"一站式"方法(同期行髂静脉支架植入术和下肢静脉曲张术)治疗Cockett综合征合并下肢静脉曲张的安全性、有效性。方法对58例Cockett综合征合并下肢静脉曲张患者行"一站式"治疗,观察并记录术后并发症情况、有无静脉曲张复发,比较术前和术后门诊随访1、3、6、12个月时静脉临床严重程度评分(VCSS)、阿伯丁静脉曲张问卷(AVVQ)评分及髂静脉支架通畅率。结果对58例患者均成功施行"一站式"治疗,技术成功率100%。3例活动性溃疡患者术后1个月内溃疡完全愈合。术后无下肢深静脉血栓、肺栓塞等严重并发症发生。术后1、3、6、12个月VCSS和AVVQ评分较术前均明显降低(P均0.001);随访至12个月,髂静脉支架通畅率为100%,无下肢静脉曲张复发。结论 "一站式"方法治疗Cockett综合征合并下肢静脉曲张的安全性和有效性良好,短期髂静脉支架内通畅率满意,具有一定推广价值。     

Interventional radiology in the airway in children

Interventional procedures in the airway can be performed in interventional radiology suites or the operating room, by radiologists or other specialists. The most common therapeutic interventions carried out by radiologists are balloon dilatation, stenting, and the treatment of certain airway fistulas. These operations can be very challenging for anesthetists in terms of planning, airway management, the identification and treatment of procedural complications and postoperative care. In particular, a multidisciplinary approach to decision‐making and planning is important to obtain the best results.     

胆管癌姑息治疗的研究进展

虽然根治性切除是胆管癌唯一的治愈方法,但是疾病诊断时患者大多已是晚期,错过了最佳手术时机。以重建胆汁引流为中心的姑息治疗能改善患者的生活质量,延长生存期。介绍了近年来胆管癌姑息性治疗的最新进展,胆道支架放置术、姑息性手术等都能使患者获益,局部和全身的辅助治疗也不可或缺,如放疗、化疗、光动力学治疗、免疫治疗等,但是其确切疗效还有待进一步研究。随着基础研究和医疗技术的不断发展,传统的治疗方法将不断改进,针对胆管癌发病机制的新型治疗方法也将发挥重要作用,共同造福广大患者。     

Late breaking trials of 2015 in coronary artery disease: Commentary covering ACC,EuroPCR, SCAI,TCT, ESC,and AHA

The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2015, including the MATRIX, ABSORB, and TOTAL trials. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2016 Wiley Periodicals, Inc.