药物洗脱支架植入与冠状动脉旁路移植术治疗多支冠状动脉病变临床疗效的对比研究

目的 评价与比较多支冠脉病变行冠状动脉旁路移植术(CABG)与药物洗脱支架(SES)植入的近期与中期治疗效果.方法 采用病历回顾的方法入选2004年7月至2007年6月在吉林省人民医院行血运重建的多支冠状动脉病变的患者.排除急性心肌梗死行原发性支架术(primary stenting)、既往行CABG、或CABG与其他心脏外科手术同期进行的患者.根据血运重建方式的不同,将患者分为二组,冠状动脉搭桥组(CABG组),156例;药物洗脱支架组(SES组),251例.记录住院期间死亡、新发心肌梗死、卒中和再次血运重建事件.以电话询问的方式,对患者出院后上述临床事件的发生情况进行回顾性随访.采用Kaplan-Meier方法分析无事件生存率,采用Logistic多元逐步回归分析不同血运重建方式对临床结果的相对影响.结果 :随访时间的中位数为779天(29.3月).随访成功率92.1%.CABG组84.1%患者使用了乳内动脉.SES组53.2%的患者植入了2个以上支架.CABG组与SES组比较,CABG组三支病变、前降支近段病变、左主干病变和慢性完全闭塞病变,及既往陈旧性心肌梗死(OMI)患者明显多于SES组.SES组糖尿病和ST段抬高心肌梗死(STEMI)的患者较多.结果 CABG组主要心脑血管事件(MACE)的发生率高于SES组(4.8%比1.2%,多因素分析:CABG与SES植入相比OR4.7,95%CI1.1-19.8,P=0.035);CABG组的死亡率高于SES组(3.8%比0.8%,多因素分析:CABG与SES植入相比OR 4.2,95%CI0.9-17.2,P=0.06),但未达到显著性水平.随访临床结果的多因素Logistic逐步回归分析显示,累积MACE、卒中和心肌梗死(MI)的发生两组差异无显著性,CABG组累积死亡率高于SES组(7.6%比3.1%,多因素分析:CABG与SES植入相比OR 2.9,95%CI1.3-6.5,P=0.012),SES组的累积血运重建率高于CABG组(8.4%比1.5%,多因素分析:SES植入与CABG比较OR6.8,95%CI3.1-15.2,P＜0.001).采用Kaplan-Meier分析显示CABG组累积生存率低于SES组,两组间差异有量著性(P=0.017),无MACE生存率两组间差异无显著性(P=0.732).以30天为分期分析,CABG组30天生存率低于SES组(95.4%比98.8%,P=0.017),两组30天后生存率差异无显著性(97.2%比98.3%,P=0.476).结论 CABG组的30天死亡率高于SES组,30天后死亡率无差异.多支冠脉病变SES植入组的中期血运重建率高于CABG组.     

雷帕霉素和紫杉醇药物洗脱支架在冠状动脉长病变中的临床应用分析

目的比较雷帕霉素和紫杉醇两种药物洗脱支架（DES）在冠状动脉长病变中的临床疗效分析。方法选择2007年1月-2008年7月期间分别接受雷帕霉素DES和紫杉醇DES的冠脉长病变患者各35例和32例,观察6个月的主要心脏事件（MACE）。结果雷帕霉素DES和紫杉醇DES两组患者支架置入成功率均为100%,随访6个月其心脏不良事件发生率分别为8.57%和9.37%,差异无统计学意义（P〉0.05）。结论雷帕霉素DES治疗冠状动脉长病变的疗效和安全性与紫杉醇DES相似,更长期的临床疗效比较尚有待于进一步随访观察。     

钴合金裸支架与雷帕霉素药物涂层支架在冠心病患者应用中的对比研究

目的比较冠状动脉内钴合金裸支架与雷帕霉素药物支架特点、临床应用的安全性和有效性,探讨钴合金裸支架治疗单支冠状动脉病变冠心病患者的安全性和临床疗效。方法分析经选择性冠状动脉造影(CAG)证实为单支病变血管直径狭窄>70%的冠心病患者204例,81例冠状动脉内置入钴合金裸支架;123例冠状动脉内置入雷帕霉素药物涂层支架,观察术后疗效、12个月内主要不良心脏事件(MACE)发生率及再狭窄率。结果两组手术成功率均为100%。两组患者置入支架的成功率、住院期间急性及亚急性血栓形成率及12个月随访MACE发生率、再狭窄率等差异无统计学意义。结论钴合金裸支架可以安全有效的应用于单支冠状动脉病变的治疗。     

雷帕霉素药物洗脱支架在复杂冠状动脉病变的应用

目的探讨雷帕霉素药物洗脱支架(Cypher)在复杂冠状动脉病变中的应用。方法选择60例复杂冠状动脉病变的冠心病患者,74处病变部位共植入96个Cypher支架,并对其临床资料、病变特征、手术成功率、术中并发症及住院期间主要心脏不良事件[MACE,包括急性心肌梗死(AMI)、再次血管重建及死亡]发生率等进行分析。结果支架植入即刻成功率为97.9%,残余狭窄率为(3.2±4.5)%。术中无死亡,住院期间死亡1例,术中及住院期间未发生AMI,无1例进行靶血管重建,住院期间MACE发生率1.67%。结论不同种类复杂冠状动脉病变选择Cypher是安全有效的,短期内MACE发生率低。     

国产雷帕霉素洗脱支架在多支病变中的疗效

目的分析国产雷帕霉素药物洗脱支架在多支血管病变介入治疗中的疗效。方法采用回顾性分析研究方法,在80例急性非ST段抬高急性冠脉综合征患者中置入国产雷帕霉素药物洗脱支架,随访住院及术后1年内主要心脏不良事件发生率。结果院内出现再发心绞痛4例。随访1年中,再发心肌梗死1例,脑梗死1例,再次冠状动脉内支架治疗9例。无死亡病例。结论国产雷帕霉素药物洗脱支架在多支血管病变介入治疗中疗效安全、有效,并发症少,再狭窄率低。     

冠状动脉弥漫性长病变的介入治疗

目的:评价冠心病患者应用长支架及多个支架序贯置入进行经皮冠状动脉介入治疗(PCI)的临床疗效。方法:对164例冠心病患者的284支靶病变血管进行了PCI,其中194支(68.3%)为弥漫性长病变,平均靶病变狭窄93.8%±8.7%。A组59例:1支靶病变血管置入单个长支架20~36mm;B组105例:至少1支靶病变血管为多个支架相连接(2~5个)。结果:A、B二组长病变置入支架的平均总长度分别为23.1±10.1mm,28.8±10.5mm(P<0.05);A、B组的PCI手术成功率均为100%,恢复TIMI 3级血流分别为93.6%、96.1%,手术即刻残余狭窄率分别为1.7%、2.1%,住院期间心血管病事件(MACE)发生率分别为3.4%、2.9%,二组间上述各项数值统计学无显著差异(P>0.05)。平均随访11.8个月,A组随访58例,MACE发生率为8.6%,无事件生存率为93.1%(54/58);B组随访101例,MACE发生率为11.9%,无事件生存率为83.8%(88/105),二组间比较,统计学无显著差异(P>0.05)。结论:冠心病患者的弥漫性长病变,应用长支架或多个支架序贯置入进行PC I,临床疗效均较好。     

雷帕霉素洗脱支架在冠心病合并2型糖尿病患者中的应用

目的评估冠心病合并2型糖尿病患者冠状动脉内植入雷帕霉素洗脱支架的临床疗效.方法 155例冠心病合并2型糖尿病患者接受冠状动脉内支架术,其中81例植入雷帕霉素洗脱支架(SES组),74例接受普通金属裸支架(BMS组),比较两组的临床一般情况、冠脉造影、支架植入术和远期综合心脏事件发生率.结果两组患者冠脉病变特点和支架植入术情况无统计学差异(P>0.05),住院期间均无严重并发症发生.平均随访1年中,SES组远期心脏不良事件发生率显著低于BMS组(P<0.001). 结论冠心病合并2型糖尿病患者植入雷帕霉素洗脱支架安全有效;与普通金属裸支架相比,雷帕霉素洗脱支架能显著降低心脏不良事件发生率.     

国产雷帕霉素药物洗脱支架的临床应用观察

目的评价国产雷帕霉素药物洗脱支架的安全性和有效性。方法对32例冠心病患者,予以置入56个国产雷帕霉素药物洗脱支架(Firebird)治疗,并进行6个月以上随访。结果即刻成功率为100%。6个月以上随访,无重要心脏不良事件,无病变靶血管重建术,再狭窄率为0%。结论Firebird能有效预防冠脉支架术后再狭窄,并具有很高的安全性。     

不同冠脉重建策略在冠心病合并糖尿病患者中的短期临床疗效比较

目的:评价裸金属支架、药物洗脱支架及冠状动脉旁路移植术在合并糖尿病的冠心病多支病变患者中的短期临床疗效.方法:本研究纳入123个接受裸金属支架(BMS)、药物洗脱支架(DES)植入或行CABG治疗的合并糖尿病的多支病变冠心病患者.回顾性收集住院病历资料及临床随访资料.比较不同冠脉重建策略组患者住院期间及随访12个月的主要不良心脑血管事件(MACCE)的发生率.结果:CABG组患者住院期间MACCE发生率(6.45%)显著高于DES组(1.89%)及BMS组(2.56%).主要表现在死亡率和卒中发生率的增高.DES组与BMS组无明显差异.CABG组在随访1年时MACCE发生率(7.41%)略低于DES组(9.76%),但没有显著性差异,二者均低于BMS组(21.21%).结论:在合并糖尿病的冠心病多支病变患者的冠脉重建中,CABG短期疗效较差,但是可以显著降低远期不良事件.DES有较好的短期疗效,并且和CABG一样,可以通过减少冠脉重建的比率获得较好的远期疗效.     

药物洗脱支架介入治疗冠状动脉多支病变的临床研究

目的：观察全部置入药物洗脱支架（DES）对冠状动脉介入治疗（PCI）多支架术患者临床结果的影响。方法：选取2004年5月1日至2009年4月30日接受冠状动脉多支架术治疗的患者共913例。根据置入支架的种类不同分为3组,分别记录三组病人的临床基本情况、冠状动脉病变的基础特征、支架置入的部位和种类、病人住院期间治疗情况及主要的心脑血管事件发生情况和出院后中位数的随访情况等,对比观察全部置入DES对PCI多支架术患者临床结果的影响。结果：全部置入DES组中既往有血管重建史的患者明显增多。单支病变全部应用DES多,占31.9%,三支病变应用DES和混合组为多,占42.3%,3组在2支病变中支架应用无差异;在左主干病变、前降支近端病变、开口病变、弥漫性病变及支架内再狭窄病变中BMS组比例最少。住院期间心脑血管不良事件（MACCE）发生率三组患者均较低。结论：全部置入DES在PCI多支架术中的应用是安全、有效的。     

雷帕霉素药物洗脱支架的早中期安全性及有效性评价

目的评价雷帕霉素药物洗脱支架（drug—elutingstent,DES）在冠脉病变介入治疗后的安全性与有效性。方法从2009年1月1日-2011年11月1日期间在我院心血管内科行冠状动脉造影并置入雷帕霉素药物洗脱支架的患者中随机筛选500例,按随访时间将其分为术后1年随访组（130例）、术后3年随访组（139例）2组。采用电话随访或门诊检查,必要时复查冠脉造影观察在支架置入后不良心血管事件发生情况及靶血管复查造影情况。结果两组不良心血管事件总体发生率有统计学差异（3．25％VS13．28％,P=0．04）,其中靶病变血运重建发生率（2．44％VS8．59％,P=0．03）有统计学意义,而心源性死亡发生率f0．81％vs2．34％,P=0．64）和非致死性心肌梗死发生率（0．00％阳2．34％,P=0．26）无统计学差异;两组造影复查支架再狭窄率（4．88％瑚14．84％,P=0．008）有统计学意义。结论支架置入术术后3年与术后1年相比有较高的靶血管血运重建率及支架再狭窄率。     

Long term clinical outcomes in patients with moderate renal insufficiency undergoing stent based percutaneous coronary intervention

Background Patients with end-stage renal disease have a high mortality from coronary artery disease, but the impact of moderate renal insufficiency on clinical outcomes after percutaneous coronary intervention （PCI） and the effect of drug-eluting stent implantation in these patients remain unclear. This study determined the long-term effect of moderate renal insufficiency on death and major adverse cardiac events （MACE） after stent based PCI and examined whether drug-eluting stent implantation could favourably influence clinical outcome. Methods Major adverse cardiac events and causes of mortality were determined for 1012 patients undergoing percutaneous intervention from January 1, 2002 to December 31, 2004 at Shanghai Ruijin Hospital. Based on estimated creatinine clearance levels, long term outcomes were compared between patients with estimated creatinine clearance 〈60 ml/min （renal insufficiency group; n=410） and those with estimated creatinine clearance ≥60 ml/min （control group; n=602）. Subgroup analysis was also made for patients with renal insufficiency between drug eluting stent （n=264） and bare metal stent implantation （n=146） during PCI. Results During follow-up （average 17 months） after successful PCI, all causes of death （7.1% vs 2.3%, P〈0.01） and cardiac death （3.4% vs 1.0%, all P〈0.01） were significantly higher in renal insufficiency group than in control group. For patients with moderate renal insufficiency, drug-eluting stent implantation reduced significantly all causes of death （5.3% vs 10.9%, P〈0.05） and occurrence of major cardiac adverse events （15.1% vs 24.6%, P〈0.05） compared with bare metal stents. Conclusions Moderate renal insufficiency is an important clinical factor influencing the mortality after PCI in patients with coronary artery disease and the use of drug-eluting stents should be the preferred therapy for the improvement of long-term outcomes in such patients.     

雷帕霉素和紫杉醇药物洗脱支架治疗冠心病复杂病变的临床近远期疗效比较

目的 比较雷帕霉素（CYPHER）和紫杉醇（TAXUS）药物洗脱支架（DES）在冠心病复杂病变中的临床近、远期疗效。方法本研究选自2002年4月至2004年6月接受雷帕霉素和紫杉醇DES治疗的冠心病患者分别611例（642处病变,共置入698个雷帕霉素支架）和450例（534处病变,共置入600个紫杉醇支架）,复杂病变的种类包括长段弥漫性狭窄、慢性完全闭塞性病变、分叉病变、支架内再狭窄,以及冠状动脉开口病变和左冠状动脉主干病变。结果 雷帕霉素和紫杉醇DES置入成功率分别为99,2％（606／611）和98．8％（445／450）,住院期间心脏事件[死亡、急性心肌梗死、靶病变血管重建,主要不良心脏事件（MACE）]发生率分别为0．65％和1．30％（P〉0．05）,6～8个月随访率分别为97.5％（596／611）和96．2％（433／450）,随访期间MACE发生率分别为2．3％和3．2％（P〉0．05）,再狭窄发生率分别为7．3％和14．0％（P〉0．05）,血栓形成发生率分别为0．49％和0．89％（P〉0．05）。结论 对于冠心病复杂性病变,雷帕霉素和紫杉醇DES均有良好的临床近、远期疗效,在再狭窄发生率方面雷帕霉素支架优于紫杉醇支架。     

强化抗血小板干预对老年冠心病患者血小板聚集率及血栓事件的影响

目的支架术后双抗血小板治疗1年与2年对老年冠心病患者血小板聚集率及血栓事件的影响。方法选取我院2012年3月至2013年3月300例老年冠心病患者为研究对象,随机分为A组与B组,每组150例。所有患者均随访2年,随访成功率为100%。A组给予支架术后双抗血小板治疗1年,B组给予支架术后双抗血小板治疗2年,其中A组根据植入支架不同分为A_1组(Excel国产支架)与A_2组(XinCEV均衡进口支架),每组75例。其中B组根据植入支架不同分为B_1(Excel国产支架)与B_2组(XinCEV均衡进口支架)。比较A、B组主要心血管(MACE)事件发生率,血小板聚集率及心源性猝死、心梗、靶血管再次PCI及出血事件。比较A1组与B1组MACE事件及A_2组与B_2组MACE事件。结果 A、B组治疗前,随访1、2年后,血小板聚集率比较无统计学意义(P0.05)。A组MACE事件发生率18.00%高于B组8.67%(P0.05);A、B组出血发生率比较无统计学意义(P0.05)。A_1组MACE事件发生率24.00%高于B1组9.33%(P0.05)。A_2组与B_2组MACE事件发生率比较无统计学意义(P0.05)。结论支架术后双抗血小板治疗2年与双抗血小板治疗1年比较,发生出血事件没有增多,可进一步有效降低MACE事件发生率,亚组分析中不同支架双抗血小板治疗1年与2年组比较有差异,本研究中进口支架XinCEV双抗血小板治疗1年与2年组比较无差异,提示此组支架抗栓1年治疗时间已经足够,而国产支架Excel需要更长疗程的双抗血小板治疗。     

Efficacy of stenting for unprotected left main coronary artery disease in 297 patients

Background Angioplasty in the unprotected left main coronary artery （LMCA） has been controversial. This study aims to evaluate the safety and clinical effectiveness of stenting, including bare metal stent and drug eluting stent （DES）, for treatment of unprotected LMCA disease. Methods Between September 1997 and December 2005, a total of 297 consecutive patients underwent percutanous coronary intervention （PCI） on LMCA lesions in our hospital. Their in-hospital data and clinical follow-up outcomes were analyzed and those in pre-DES ＂＇era＂ （group I, from September 1997 to December 2002） were compared with those in DES ＂era＂ （group Ⅱ, from January 2003 to December 2004. Patients in 2005 for the time of follow-up less than one year were not included in this group）. Results Altogether 368 coronary stents were successfully deployed in 295 patients. Stents failed to be implanted after balloon predilation in two patients, who received coronary artery bypass graft （CABG） successfully. Bifurcation techniques for distal LMCA executed in 206 patients （69.4%, 2061297）, included crossover stenting in 156 （75.7%）, T stenting in 4 （1.9%）, provisional T stenting in 28 （13.6%）, kissing stenting in 5 （2.4%） and stent crushing in 13 （6.3%） patients. During their hospital stay, 5 （1.7%） patients died after PCI procedure, of which 4 died from cardiac origin and one of renal failure. The total in-hospital major adverse cardiac events （MACE） were 2.0% （6/297）. In the follow-up period, 19 patients （6.5%） died [15 （5.1%） of cardiac death and 4 of non-fatal myocardial infarction （MI）]. Besides, 2 （0.7%） developed subacute thrombosis （SAT） and 16 （5.4%） performed target lesion revascularization （TLR）. The total follow-up MACE was 14.5% （431297）. Further analysis also showed that, compared with patients in group I, those in group II apparently had more multi-vessel involvement （14.7% vs 81.9%, P〈0.001）, and more bifurcation lesions （32.4% vs 72.2%, P〈0.001）. After PCI, in-hospital MACE of group II was significantly lower than that in group I （1.1% vs 9.4%, P〈0.05）. And the incidences of MACE, TLR and angiographic restenosis in group II were all significantly lower than those in group I （all P〈0.05） after one year follow-up. Conclusions As new PCI strategies and intervention devices such as DES are developed, coronary stenting, which might have brought better in-hospital and long-term outcomes than CABG are proved to be technically successful and can be safely applied for the treatment of LMCA lesions in the experienced center for coronary intervention.     

冠心病合并糖尿病患者应用雷帕霉素洗脱支架和紫杉醇涂层支架的疗效观察

目的:评价雷帕霉索洗脱支架(Cypher~(TM))和紫杉醇涂层支架(Taxus~(TM))治疗冠心病(CAD)合并2型糖尿病(DM)患者短期疗效和安全性。方法:从2002年12月至2006年3月共116例合并CAD和DM的患者入选本研究,共植入药物涂层支架186个(雷帕霉素洗脱支架97个,紫杉醇涂层支架89个)。观察6个月的主要心血管不良事件(MACE)。结果:接受两种支架植入的患者基本临床特征相似。支架植入成功率100%,95%的患者完成了6个月的随访。雷帕霉素洗脱支架组总的MACE事件发生率约为6．78%(4/59),紫杉醇涂层支架组总的MACE事件发生率约为7．02%(4/57),两组相比无统计学差异。结论:雷帕霉素洗脱支架和紫杉醇涂层支架治疗CAD合并2型DM的患者有相似的疗效。     

Outcomes after primary coronary intervention with drug-eluting stent implantation in diabetic patients with acute ST elevation myocardial infarction

Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P=0.03) and had longer time delay from symptom onset to admission ((364±219) minutes and (309±223) minutes, P=0.02) than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P&lt;0.001). Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG) ≥2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P=0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P=0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P=0.03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P=0.02). Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P=0.19). All of these patients experienced non-fatal myocardial infarction.Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.     

A comparison of clinical and angiographic outcomes after Excel bioabsorbable polymer versus Firebird durable polymer rapamycin-eluting stent for the treatment of coronary artery disease in a “real world” setting: six-month follow-up results

Background Several clinical trials have shown that rapamycin-eluting stents significantly reduce the risk of restenosis after percutaneous coronary intervention (PCI). The Firebird stent and the Excel stent (coated with bioabsorbable polymer) are two different types of rapamycin-eluting stents made in China, both have been recently approved for clinical use in China by State Food and Drug Administration. However, it is unclear whether there are differences in safety and efficacy between the two types of stents in daily practice. Methods In the month of June 2006, a total of 190 consecutive patients were treated exclusively with Firebird stents (n=93, Firebird group) or Excel stents (n=97, Excel group) in our center and were included in this study. The frequency of major adverse cardiac events (MACE, a composite of death, myocardial infarction or target lesion revascularization), binary restenosis, and late lumen loss and stent thrombosis during a six-month follow-up period were compared between the two groups.Results Patient and lesion characteristics were comparable between the groups. Major adverse cardiac event rates were low in hospital and at 6 months (2.1% in the Excel group and 0% in the Firebird group, P﹥0.05). The 6-month angiographic in-stent restenosis rate was 0% in both groups, with an associated late loss of (0.15 ± 0.21) mm versus (0.14 ± 0.20) mm (P=0.858) and the in-segment restenosis rate was also 0% for the Excel group and the Firebird group. There was no definite stent thrombosis identified in either group during the six-month follow-up period and only one patient in the Excel group had probable stent thrombosis in hospital. Conclusions Results from this mid-term, single-center study showed that both of the Firebird and the Excel rapamycin eluting stent had similar effects on reducing the incidence of MACE and the risk of restenosis (both in-stent and in-segment binary restenosis) after PCI in daily practice.     

Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation

Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in the drug-eluting stent （DES） era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.
Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission （RD group）, and the remaining 533 patients had normal renal function （non-RD group）. The primary endpoint was 30-day major adverse cardiac events （MACE, including death, non-fatal reinfarction, and target vessel revascularization）, and the secondary endpoint was subacute stent thrombosis.
Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 （29.1% vs 18.6%, P=0.02） and multi-vessel （62.8% vs 44.5%, P=0.001） and triple vessel disease （32.6% vs 18.2%, P=0.002）, in-hospital mortality （9.3% vs 3.8%, P=0.03）, and MACE rate during hospitalization （17.4% vs 7.7%, P=-0.006） were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group （76.7% vs 89.9%, P=-0.0003）. Angiographic stent thrombosis occurred in 3 （3.5%） and 7 （1.3%） of patients in the RD group and non-RD group, respectively （P=0.15）. Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up （Hazard ratio （HR） 3.31,95% CI 1.19-9.18, P 〈0.001）.
Conclusion Despite similar prevalence of stent thromb     

Long-term outcome of patients of over 85 years old with acute coronary syndrome undergoing percutaneous coronary stenting: a comparison of bare metal stent and drug eluting stent

Background Patients aged over 85 years have been under-represented in percutaneous coronary intervention （PCI） trials despite an increase in referrals for PCI. The long-term safety and efficacy of percutaneous coronary stenting in patients aged over 85 years with acute coronary syndrome （ACS） remain unclear. Moreover it is unknown whether there are differences between bare metal stent （BMS） and drug eluting stent iDES） in this special population.
Methods A total of 80 patients with ACS aged over 85 years undergoing stenting （BMS group n=21 vs DES group n=59） were retrospectively studied. In-hospital, one year and overall clinical follow-up （12-36 months） of major adverse cardiac events （MACEs） including cardiac deaths, myocardial infarction, target lesion revascutarization （TLR） and target vessel revascularization （TVR） as well as stroke and other major bleeding were compared between the two groups.
Results In the entire cohort, the procedure success rate was 93.8% with TIMI-3 coronary flow post-PCI in 93.8% of the vessels and the procedure related complication was 17.5%. The incidence of in-hospital MACEs in BMS group was higher （14.3% vs 6.8%, P=0.30）. The 1-year incidence of MACEs in DES group was 7.0% while there was no MACE in the BMS group. Clinical follow-up for 12-36 months showed that the overall survival free from MACE was 82.9% and the incidence of MACE in the BMS group was lower （5.3% vs 21.1%, P=0.20）. Multivariate regression analysis showed that the creatinine level （OR：. 1.013; 95%CI： 1.006-1.020; P=0.004） and hypertension （OR; 3.201; 95%CI： 1.000-10.663; P=0.04） are two major factors affecting the long-term MACE.
Conclusions Percutaneous coronary stenting in patients aged over 85 years is safe and provides good short and tona-term efficacy. Patients with renal dvsfunction and hvoertension may have a relatively hiah incidence of MACE.