可降解涂层与不可降解涂层雷帕霉素洗脱支架在急性心肌梗死直接经皮冠状动脉介入治疗中的疗效比较

目的 比较可降解涂层雷帕霉素洗脱支架(Excel)与不可降解涂层雷帕霉素洗脱支架(Cypher Select)在急性ST段抬高型心肌梗死直接经皮冠状动脉介入治疗中的有效性和安全性.方法 连续入选的228例急性ST段抬高型心肌梗死患者随机分至Cypher组(113例)和Excel组(115例).主要终点为术后12个月主要不良心脏事件(包括死亡、心肌梗死和靶血管重建),次要终点为9个月晚期管腔丢失和支架再狭窄.结果 术后9个月Cypher组和Excel组分别有43例(38.1%)和48例(42.1%)患者接受冠状动脉造影随访,两组支架内晚期管腔丢失[(0.17±0.26)mm比(0.18±0.33)mm,P=0.483]、节段内晚期管腔丢失[(0.19±0.36)mm比(0.20±0.42)mm,P=0.419)和支架内再狭窄(2.3%比2.1%,P=0.937)、节段内再狭窄(4.7%比6.3%,P=0.738)的发生率差异无统计学意义.术后12个月Cypher组和Excel组死亡(3.5%比2.6%,P=0.692)、心肌梗死(1.8%比2.6%,P=0.658)、靶血管重建(1.8%比2.6%,P=0.658)、主要不良心脏事件(5.3%比6.1%,P=0.788)及支架内血栓形成(4.4%比3.5%,P=0.724)的发生率差异无统计学意义.结论 可降解涂层与不可降解涂层雷帕霉素洗脱支架在直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死中的近期疗效和安全性可能是一致的,其远期效果有待进一步研究.     

急性ST段抬高心肌梗死直接经皮冠状动脉介入后残余ST段抬高与预后的关系

目的探讨急性ST段抬高心肌梗死（STEMI）直接经皮冠脉介入（PCI）后心电图残余ST段抬高总和与预后的关系。方法依据PCI后心电图残余ST段抬高总和（sumSTE）的程度将患者分为A组（sumSTE〈0.1mV）、B组（0.1mV≤sumSTE〈0.3mV）、C组（0.3mV≤sumSTE〈0.7mV）和D组（≥0.7mV）,观察sumSTE与住院期间左室射血分数（LVEF）及6月内总的主要心血管事件（MACE,包括心绞痛、再发心肌梗死、因心血管事件再入院、心衰和死亡等）发生率的关系。结果共有225例患者。男性156例,女性69例,年龄（61.3±12.7）岁。急性前壁梗死118例,非前壁心肌梗死107例。A组LVEF明显高于C组（57.68±6.72%比54.33±8.50%）和D组（57.68±6.72%比51.27±9.20%）。B组LVEF高于C组（57.60±8.40%比54.33±8.50%）和D组（57.60±8.40%比51.27±9.20%）。C组LVEF高于D组（54.33±8.50%比51.27±9.20%）。A、B组两组患者随访MACE发生率差异无统计学意义。但A组MACE发生率低于C组（14.1%比33.3%,χ2=6.164,P=0.012）和D组（14.1%比50.5%,χ2=19.392,P=0.001）。B组、C组两组患者随访MACE发生率差异无统计学意义（26.1%比33.3%,χ2=0.621,P=0.285）。但B组MACE发生率低于D组（26.1%比50.5%,χ2=6.674,P=0.008）。C组MACE发生率显著低于D组（33.3%比50.5%,χ2=3.582,P=0.044）。结论 STEMI患者PCI术后残余ST段抬高与患者住院期间左室EF值、6个月内MACE发生率相关。     

药物洗脱支架血栓形成并发急性ST段抬高型心肌梗死的预后研究

目的 分析药物洗脱支架(DES)血栓形成引起急性ST段抬高型心肌梗死(STEMI)的临床和直接冠状动脉介入治疗(PCI)特征及预后.方法 31例因DES血栓形成引起STEMI(ST组)和93例由原发冠状动脉病变所致STEMI患者(对照组)接受直接PCI治疗.记录各例临床和PCI特征及1年随访结果.研究主要终点为院内及1年累积主要心脏不良事件(MACE),包括死亡、非致命性再梗死及靶血管再次血运重建(TVR).结果 与对照组比较,ST组年龄较大(69.9±11.4岁比63.7±13.6岁,P=0.01),糖尿病(41.9%比22.6%,P=0.04)和既往心肌梗死史(29.0%比11.8%,P=0.02)明显增多;直接PCI后冠状动脉TIMI 3级血流显著降低(45.2%比92.5%,P＜0.001).ST组院内死亡率(16.1%比3.2%,P=0.01)和MACE发生率(25.8%比7.5%,P:0.007)显著增高,术后1年总生存率及无MACE生存率显著降低(分别为77.4%比92.5%,P=0.016;59.4%比85.1%,P=0.001).结论 DES血栓形成引起STEMI患者即使接受直接PCI治疗,其院内死亡及MACE发生率仍显著高于由原发冠状动脉病变所致的心肌梗死患者.     

国产雷帕霉素洗脱支架在急性ST段抬高型心肌梗死中的应用

目的:评价国产雷帕霉素支架在急性ST段抬高型心肌梗死中应用的安全性和有效性,并观察其近、中期临床疗效. 方法:将147例急性ST段抬高型心肌梗死、发病12h以内在我院接受急诊介入治疗的患者随机分为2组,分别植入国产药物支架(Firebird支架组,n=78)和金属裸支架(Driver支架组,n=69).2组年龄、性别、发病时间、病变特征等基础临床情况无显著差异.78支罪犯血管植入Firebird支架83枚,69支罪犯血管植入Driver支架72枚.比较2组住院期和1年随访期的临床转归. 结果:2组所用支架长度、内径、术中扩张峰值压力及操作时间无明显差异;术后患者达TIMI 3级血流的比例相似.住院期间手术成功率无统计学差异(93%对95 %,P>0.05).1年随访期内Firebird组与Driver组造影随访率分别为53%和49 %,Driver支架组再狭窄率高于Firebird组(24%对2.5%,P<0.05),2组均未发生支架内血栓及心源性死亡. 结论:国产药物支架对急性ST段抬高型心肌梗死有较好的安全性和临床近、中期疗效.     

药物洗脱支架与金属裸支架在急性ST段抬高心肌梗死急诊介入治疗中应用长期随访结果的比较

目的 探讨与金属裸支架(BMS)相比,Cypher支架(Cordis公司,美国)在急性ST段抬高心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)中应用的安全性和长期有效性.方法 连续选择2002年12月至2005年3月间STEMI患者407例,均于发病12 h内行急诊PCI治疗,于梗死相关血管靶病变置入Cypher支架或BMS.对所有病例随访1.5～4.0年(平均28.7±11.7个月),比较两类支架院内及出院后严重心脏不良事件(MACE,包括死亡、再发心肌梗死、靶病变重建等)发生的差异.结果 407例患者中置入Cypher支架者131例,置入BMS者276例.Cypher支架组所置入支架的直径明显小于BMS组(3.0 mm与3.2 mm,P=0.00).两组在随访期间心因性死亡(1.5%与6.9%,P=0.02)以及随访期间总的主要不良心脏事件(MACE)(6.1%与12.7%,P=0.04)差异均有统计学意义.应用Cox回归比例风险模型计算Cypher支架组在随访期间发生总MACE的相对危险度为0.45(P＜0.05).两组的支架内血栓形成发生率差异无统计学意义,支架内再狭窄发生率以及靶病变重建率差异亦无统计学意义,但Cypher支架较之BMS有明显降低的趋势.结论 在STEMI的急诊PCI治疗时,置入Cypher支架具有较好的安全性和长期有效性,与BMS相比可以降低远期复合MACE以及心因性死亡的发生率. 2)以及随访期间总的主要不良心脏事件(MACE)(6.1%与12.7%,P=0.04)差异均有统计学意义.应用Cox回归比例风险模型计算Cypher支架组在随访期间发生总MACE的相对危险度为0.45(P＜0.05).两组的支架内血栓形成发生率差异无统计学意义,支架内再狭窄发生率以及靶病变重建率 异亦无统计学意义,但Cypher支架较之BMS有明显降低的趋势.结论 在STEMI的急诊PCI治疗时,置人Cypher支架具有较好的安全性和长期有效性,与BMS相比可以降低远期复合MACE以及心因性死亡的发生率. 2)以及随访期间总的主要不良心脏事件(MACE)(6.1%与12.7%,P=0.04)差异均有统计学意义.应用Cox回归比例风险模型计算Cypher支架组在随访期间发生总MACE的相对危险度为0.45(P＜0.     

依替巴肽冠状动脉内给药治疗ST段抬高型心肌梗死的疗效评价

目的比较直接经皮冠状动脉介入术(PCI)治疗急性ST段抬高型心肌梗死(STEMI)时冠状动脉内或外周静脉内给予依替巴肽的临床疗效和安全性。方法计算机生成随机数后将52例STEMI患者分为两组:冠状动脉负荷组(冠状动脉组,n=26)和静脉治疗组(静脉组,n=26)。记录并分析患者术后TIMI血流分级(TFG)及修正的TIMI血流帧数(cTFC),术后90 min心电图ST段回落(STR),术后心脏功能参数,住院期间发生的任何出血事件及术后30 d主要不良心脏事件(MACE)。结果两组间TFG(χ~2=2.44,P=0.313)、MACE(3.8%比0,χ~2=0.00,P=1.000)、左心室射血分数(58.54%±4.56%比56.62%±6.69%,t=1.211,P=0.232)、左心室舒张末期内径[(49.96±4.85)mm比(51.42±6.35)mm,t=0.962,P=0.351]及室壁运动异常(80.77%比73.08%,χ~2=0.435,P=0.510)比较差异均无统计学意义。冠状动脉组完全STR回落比例显著高于静脉组(88.46%比61.54%,χ~2=5.24,P=0.025)。冠状动脉组cTFC帧数也明显少于静脉组(16.44±4.61比18.30±5.61,t=2.30,P=0.028)。两者间出血事件差异无统计学意义(3.85%比11.54%,χ~2=1.063,P=0.303)。结论对于急性STEMI行直接PCI术的患者,仅冠状动脉内负荷依替巴肽治疗方案可以改善术后心肌再灌注水平,是临床实践中可供选择的治疗方法。     

直接冠状动脉内支架置入术对急性心肌梗死无复流的影响

目的评价直接冠状动脉(冠脉)内支架置入术对ST段抬高型急性心肌梗死无复流的影响。方法对157例ST段抬高型急性心肌梗死患者分别行直接冠脉内支架置入(直接支架组,85例)和球囊预扩张后支架置入(常规支架组,72例)。比较两组介入治疗时平均X线曝光时间、造影剂用量、术后TIMI血流分级和心电图ST段变化。结果直接支架组和常规支架组比较,前者节省球囊,平均X线曝光时间和造影剂用量均显著降低[(24.6±16.9)minvs(34.4±17.5)min,(115±37)mLvs(166±61)mL;P均<0.05];二者术后TIMI3级差异无统计学意义(91.8%vs83.3%,P=0.107);前者TIMI0~1级未见显著降低,但有明显的下降趋势(3.5%vs11.1%,P=0.064);前者心电图ST段无回落发生率显著降低(22.4%vs41.7%,P=0.009)。结论对于ST段抬高型急性心肌梗死中适当的冠脉病变,直接冠脉内支架置入术不仅可以节省球囊,减少X线曝光时间和造影剂用量,而且可能减少无复流发生。     

老年急性ST段抬高心肌梗死患者应用国产雷帕霉素药物洗脱支架5年临床随访

目的评估老年急性ST段抬高心肌梗死(STEMI)患者应用国产支架的长期安全性。方法入选年龄≥60岁的急性STEMI患者113例,随机分为国产雷帕霉素药物洗脱支架(DES)组56例和金属裸支架(BMS)组57例。随访5年,观察支架内血栓形成和主要心脏不良事件(MACE)发生率情况。结果 5年随访期间,DES组与BMS组病死率分别为7.1%和7.0%(P>0.05);DES组靶病变重建、MACE分别为10.7%、23.2%,BMS组分别为28.1%、42.1%(P<0.05)。DES组支架内血栓、极晚期支架内血栓发生率分别为8.9%、3.6%;BMS组分别为7.0%、1.8%,2组比较差异无统计学意义。结论老年急性STEMI患者应用国产雷帕霉素DES较BMS明显降低MACE,且极晚期血栓发生率无明显升高。     

药物洗脱支架治疗支架内再狭窄的对照研究

目的 比较3种药物洗脱支架(DES)治疗支架内再狭窄的长期临床效果.方法 回顾性分析阜外医院对支架内再狭窄病例用DES行经皮冠状动脉介入治疗(PCI)的390例患者,其中雷帕霉素药物洗脱支架(Cypher)组187例(C组),紫杉醇药物涂层支架(Taxus)组89例(T组),国产雷帕霉素涂层支架(Firebird)组114例(F组).结果 T组不稳定性心绞痛比率高于另2组,F组左主干病变比率低于另2组,而3支病变比率高于另2组.3组平均临床随访时间为864、848和719 d,主要不良心脏事件发生率差异无统计学意义(P=0.081),3组总的支架内血栓发生率差异无统计学意义(P=0.605).7个月造影随访支架内和血管段再狭窄率T组有增高的趋势(17.9%比29.4%比13.6%.P=0.214和21.8%比35.3%比15.9%,P=0.132).支架内和血管段的晚期丢失T组均明显大于另外2组[(0.31±0.12)mm比(0.75±0.24)mm比(0.31±0.13)mm,P=0.000和(0.33±0.18)mm比(0.61±0.23)mm比(0.31±0.14)mm,P=0.001].结论 3种DES治疗支架内再狭窄病变的长期疗效相似,Cypher和Firebird抑制内膜增生的作用更强.     

BuMA与Endeavor冠状动脉支架系统的安全性和有效性评估

目的比较BuMA生物降解药物涂层冠状动脉支架系统与Endeavor冠状动脉支架系统的有效性和安全性。方法采用前瞻性、平行对照、多中心、非劣效性检验研究,国内9个中心参与研究,2008年2月至2008年8月同期入选224例无症状心肌缺血、稳定型或不稳定型心绞痛及心肌梗死超过1周,需要行冠状动脉支架置入术的患者,其中BuMA支架组(试验组)113例,Endeavor支架组(对照组)111例。研究的主要终点为支架置入后(270±30)d使用定量冠状动脉造影(QCA)测定的晚期管腔丢失。次要终点为支架置入后30 d、90 d、180 d、270 d、360 d和540 d的主要不良心血管事件(MACE)、支架血栓事件,并继续随访到术后720 d。结果支架置入后(270±30)d的晚期管腔丢失,BuMA组和Endeavor组分别为0.24 mm和0.50 mm,差异有统计学意义。支架置入后540 d的MACE发生率,BuMA组为6.19%,Endeavor组为8.11%(χ2=0.3097,P=0.5788)。继续随访到术后720 d,MACE发生率,BuMA组仍为6.19%,Endeavor组为9.91%(χ2=1.0533,P=0.3048)。结论 BuMA生物降解药物涂层冠状动脉支架与Endeavor冠状动脉支架相比,能够显著减少晚期管腔丢失,提示BuMA支架在降低支架再狭窄方面可能优于Endeavor支架且具有良好的安全性和有效性。     

Comparison of drug-eluting stents with bare metal stents in unselected patients with acute myocardial infarction.

OBJECTIVES: The aim of this study was to compare the procedural characteristics and outcomes of patients with acute myocardial infarction treated with drug-eluting stents (DES) vs. bare metal stents (BMS). BACKGROUND: DES have been shown to reduce the incidence of restenosis and target vessel revascularization (TVR) in clinical randomized studies when compared with BMS in patients undergoing elective percutaneous intervention. Limited data are available with the use of DES in patients with acute ST-segment elevation myocardial infarction. METHODS: Two hundred and sixty-one consecutive patients who presented with myocardial infarction between 7/2001 and 8/2005 were studied. The procedural characteristics, 30-day and 12-month outcomes of 131 patients treated with DES were compared with 130 patients treated with BMS. RESULTS: At 12-months follow-up DES therapy was associated with a substantial decrease in major adverse cardiovascular events (MACE) (HR 0.33; P =0.002), TVR (HR 0.19; P =0.002), and recurrent myocardial infarction (HR 0.23; P =0.051) vs. BMS therapy. Coronary interventions utilizing DES were characterized by a marked increase in the number of stent per target vessel (DES: 1.9 +/- 0.9 vs. BMS: 1.38 +/- 0.6, P < 0.0001), treatment of bifurcation (DES: 21% vs. BMS: 5%, P =0.0004), and multivessel intervention (DES: 22% vs. BMS: 8%, P =0.003). CONCLUSION: The routine use of DES in acute myocardial infarction is associated with reduced rates of MACE at 12 months vs BMS, despite a higher rate of complex procedures in the DES treated patients. In addition to its anti-restenosis effect, the improved outcome of patients treated with DES may be linked to a more complete revascularization in association with prolonged clopidogrel therapy.     

Drug-eluting stents are associated with similar cardiovascular outcomes when compared to bare metal stents in the setting of acute myocardial infarction

BACKGROUND: Recent randomized trials have demonstrated conflicting results regarding the use of drug-eluting stents (DESs) as compared to bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI). We compared outcomes among patients presenting with acute ST-elevation myocardial infarction (STEMI) who received DES with those who received BMS. METHODS: In-hospital, 30-day, 6-month, and 1-year outcomes of a cohort of 122 patients who underwent primary or facilitated PCI and received a BMS were compared to 122 propensity-matched patients who received a DES. Seventy-two patients received sirolimus-eluting stents, and 50 received paclitaxel-eluting stents. RESULTS: Baseline demographics were similar among groups. One-, 6-, and 12-month outcomes, including reinfarction, death, stent thrombosis, and target vessel revascularization (TVR), were similar among groups. At 1 year, all-cause mortality was 13.3% in the BMS group and 9.2% in the DES group [P=not significant (ns)], recurrent MI was 5.3% in the BMS group vs. 4.4% in the DES group (P=ns), and TVR was 7% in the BMS group vs. 8.7% in the DES group (P=ns). CONCLUSIONS: Our data do not support the general use of DES in the setting of STEMI given similar cardiovascular outcomes among patients receiving BMS or DES, the need for long-term dual antiplatelet therapy with DES, and the possible repercussions of very late stent thrombosis.     

Outcomes of drug-eluting stents compared to bare-metal stents in ST-segment elevation acute myocardial infarction

IntroductionPrimary percutaneous coronary intervention (PPCI) has become the treatment of choice in patients with ST-segment elevation myocardial infarction (STEMI). Drug-eluting stents (DES) reduce restenosis compared to bare-metal stents (BMS) but there is conflicting data concerning their use in the setting of STEMI. We aimed to evaluate the influence of the type of stent on the outcomes of PPCI.MethodsThis was a single-center longitudinal study including 213 consecutive patients (76% men, mean age 60±12 years) with STEMI undergoing PPCI between 2003 and 2007, divided into two groups: BMS (43.7%) and DES (56.3%). We assessed clinical and demographic features as well as angiographic and electrocardiographic signs of myocardial reperfusion. The composite outcome of death, myocardial infarction (MI) or target-lesion revascularization (TLR) was evaluated.ResultsAt a median follow-up of 26 months there were no differences in the composite outcome of death/MI/TLR (BMS 18.3% vs DES 15.8%) or in the incidence of stent thrombosis. Angiographic results of the procedure were also similar. Independent predictors of the composite outcome were age (HR=1.06, 95% CI [1.02-1.11], left anterior descending artery as infarct-related vessel (HR=2.69, 95% CI [1.17-6.19]) and use of glycoprotein IIb/IIIa inhibitors (HR=0.33, 95% CI [0.13-0.83]).ConclusionsThere was no benefit in angiographic outcomes or major cardiac events after treatment with drug-eluting stents compared to bare-metal stents in this group of patients with STEMI.     

Comparison of long-term clinical and angiographic outcomes following implantation of bare metal stents and drug-eluting stents in aorto-ostial lesions

Percutaneous coronary intervention (PCI) to aorto-ostial (AO) lesions is technically demanding and associated with high revascularization rates. The aim of this study was to assess outcomes after bare metal stent (BMS) compared to drug-eluting stent (DES) implantation after PCI to AO lesions. A retrospective cohort analysis was conducted of all consecutive patients who underwent PCI to AO lesions at 2 centers. Angiographic and clinical outcomes in 230 patients with DES from September 2000 to December 2009 were compared to a historical control group of 116 patients with BMS. Comparison of the baseline demographics showed more diabetics (32% vs 16%, p = 0.001), lower ejection fractions (52.3 ± 9.7% vs 55.0 ± 11.5%, p = 0.022), longer stents (17.55 ± 7.76 vs 14.37 ± 5.60 mm, p <0.001), and smaller final stent minimum luminal diameters (3.43 ± 0.53 vs 3.66 ± 0.63 mm, p = 0.001) in the DES versus BMS group. Angiographic follow-up (DES 68%, BMS 66%) showed lower restenosis rates with DES (20% vs 47%, p <0.001). At clinical follow-up, target lesion revascularization rates were lowest with DES (12% vs 27%, p = 0.001). Cox regression analysis with propensity score adjustment for baseline differences suggested that DES were associated with a reduction in target lesion revascularization (hazard ratios 0.28, 95% confidence interval 0.15 to 0.52, p <0.001) and major adverse cardiac events (hazard ratio 0.50, 95% confidence interval 0.32 to 0.79, p = 0.003). There was a nonsignificantly higher incidence of Academic Research Consortium definite and probable stent thrombosis with DES (n = 9 [4%] vs n = 1 [1%], p = 0.131). In conclusion, despite differences in baseline characteristics favoring the BMS group, PCI with DES in AO lesions was associated with improved outcomes, with lower restenosis, revascularization, and major adverse cardiac event rates.     

药物洗脱支架在老年急性心肌梗死患者治疗中疗效观察

目的评价药物洗脱支架治疗老年ST段抬高型急性心肌梗死（AMI）患者的安全性和有效性。方法连续性收集2005年1月-12月行直接介入治疗的105例60岁及以上的老年ST段抬高型AMI患者，其中，49例接受药物洗脱支架植入，56例接受金属裸支架植入，对两组患者术后30d和240d的主要心血管不良事件（包括死亡、非致死性再梗死和靶血管血运重建）进行随访、分析。结果药物洗脱支架组和金属裸支架组的手术成功率差异无统计学意义（96％与95％，P〉0．05）。术后30d内，药物洗脱支架组和金属裸支架组的心脏不良事件发生率差异无统计学意义（8、2％与12．5％，P〉0.05），两组由冠状动脉造影证实的早期支架内血栓发生率差异无统计学意义（2．0％与1．8％，P〉0.05）。术后240d随访，与金属裸支架植入比较，药物洗脱支架植入能明显减少心脏不良事件发生率[12．2％与30、0％，相对危险比为0、38，95％可信限（CI）：0、12～0、96，P〈0.053，靶血管血运重建率显著降低[2.0％与25．0％，相对危险比为0．08（95％CI：0．01～0.63），P〈0．01]。术后30～240d，两组未发生晚期支架内血栓。结论与金属裸支架比较，药物洗脱支架应用于老年ST段抬高型AMI患者可能并不增加支架内血栓的中期发生率，同时可以降低患者8个月靶血管再次血运重建率。     

Clinical results of drug eluting stents compared to bare metal stents for patients with ST elevation acute myocardial infarction

OBJECTIVE: To investigate the clinical outcomes in patients with ST segment elevation acute myocardial infarction (STEMI) treated with drug eluting stents (DES) versus a matched control group of patients with STEMI treated with bare metal stents (BMS). METHODS: This registry included 122 patients with STEMI undergoing primary coronary angioplasty with DES implantation at our institution. The control group consisted of 506 patients implanted with BMS, who were matched for age, infarct location, and diabetic status. The incidences of major adverse cardiac events (MACE) including target vessel/lesion revascularization (TVR/TLR) and stent thrombosis were assessed up to 12 months. RESULTS: Twelve months follow up showed a non-significant trend towards reduced deaths (3.3% versus 7.1%, P=0.1), significantly reduced recurrent MI (0.0% versus 6.1%, P=0.02), TVR (5.7% versus 15.2%, P=0.006) and TLR (2.5% versus 14.0%, P=0.004) events in the DES group as compared to BMS group. The composite incidences of MACE at 12 months follow-up was lower in the DES group (11.5%) as compared to the BMS group (21.3%, P=0.01). CONCLUSION: According to our experiences, the use of DES in STEMI is safe and effective as compared to BMS. DES was effective in reducing the incidence of restenosis outcomes and overall adverse cardiac events up to 12 months.     

Improved survival with drug-eluting stent implantation in comparison with bare metal stent in patients with severe left ventricular dysfunction.

OBJECTIVE: We examined the efficacy of drug-eluting stent (DES) implantation (Sirolimus or Paclitaxel) in patients with ischemic cardiomyopathy and severe left ventricular (LV) dysfunction and compared the outcome with a similar group of patients undergoing bare metal stent (BMS) implantation. BACKGROUND: Patients with severe LV dysfunction are a high risk group. DES may improve the long term outcomes compared with BMS. METHODS: One hundred and ninety one patients (23% women) with severe LV dysfunction (LV ejection fraction < or =35%) underwent coronary stent implantation between May 2002 and May 2005 and were available for follow-up. One hundred and twenty eight patients received DES (Sirolimus in 72 and Paclitaxel in 54) and 63 patients had BMS. Patients with acute S-T elevation myocardial infarction (STEMI) were excluded. The primary endpoint was cardiovascular mortality. A composite endpoint of major adverse cardiac events (MACE) including cardiovascular mortality, myocardial infarction (MI), and target vessel revascularization (TVR) was the secondary endpoint. RESULTS: Mean follow-up was 420 +/- 271 days. No differences were noted in age (69 +/- 10 years vs. 70 +/- 10 years, P = NS), number of vessel disease (2.3 +/- 0.7 vs. 2.2 +/- 0.8, P = NS), history of congestive heart failure (47% vs. 46%, P = NS), MI (60% vs. 61%, P = NS), or number of treated vessels (1.3 +/- 0.5 vs. 1.3 +/- 0.6, P = NS) for the DES and BMS group, respectively. Diabetes was more common among DES patients (45% vs. 25%, P = 0.01). The left ventricular ejection fraction (LVEF) was similar between the two groups (28% +/- 6% vs. 26% +/- 8%, P = NS for the DES and BMS, respectively). During the follow-up, there were a total of 25 deaths of which two were cancer related (2 in DES group). There were 23 cardiac deaths, 8/126 (6%) which occurred in the DES group and 15/63 (24%) in the BMS group (P = 0.05 by log-rank test). MACE rate was 10% for the DES group and 41% for the BMS group (P = 0.003). NYHA class improved in both groups (from 2.5 +/- 0.8 to 1.7 +/- 0.8 in DES and from 2 +/- 0.8 to 1.4 +/- 0.7 in the BMS, P = NS). CONCLUSION: Compared with bare-metal stents, DES implantation reduces mortality and MACE in high risk patients with severe left ventricular dysfunction.     

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.     

Long-term safety and effectiveness of drug-eluting stents compared to bare metal stents in ST elevation myocardial infarction: findings from the Guthrie Health Off-label Stent (GHOST) Registry

Background: Multiple randomized trials and observational studies have shown drug‐eluting stents (DES) to be safe and effective at 3‐year follow‐up in stent thrombosis (ST)‐segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). However, outcomes data beyond 3–4 years after DES implantation are sparse. Methods: We studied 554 STEMI patients who underwent successful PCI with either DES or bare metal stent (BMS). Primary study end‐points were time to occurrence of ST and the composite of death or myocardial infarction (MI). Secondary end‐points were time to occurrence of major adverse cardiac events (MACEs) and discrete events that comprise MACE (death, MI, and target vessel revascularization [TVR]). Outcomes of the DES and BMS groups were assessed by survival analysis and multivariable Cox regression. Results: There were 205 (37%) patients who received DES and 349 (63%) patients who received BMS. At a median follow‐up of 41.4 months after PCI, there were no differences in the unadjusted incidence of ST (ST, 3.4 vs. 4.3%, log‐rank P = 0.61) and MI (6.8% vs. 8%, P = 0.61) between DES versus BMS groups, respectively. However, DES implantation was associated with lower unadjusted incidence of death or MI (11% vs. 23.5%, P = 0.0002), MACE (16% vs. 34%, P < 0.0001), death (6.3% vs. 17%, P = 0.0004), and TVR (9.8% vs. 18%, P = 0.008) than BMS implantation. In multivariable analyses, DES implantation was associated with significantly lower incidence of MACE (adjusted HR = 0.47 [95% CI: 0.31–0.76], P = 0.0007) than BMS implantation. Conclusion: In our study of STEMI patients, DES implantation was safer than BMS implantation and was associated with lower MACE at long‐term follow‐up. (J Interven Cardiol 2012;25:118–125)     

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.