40岁以下冠心病患者的冠状动脉病变特点及其危险因素的病例对照研究

目的：探讨国人４０岁以下冠心病患者的冠状动脉（冠脉）病变特点及其危险因素。方法：根据冠脉造影结果将４０岁以下行冠脉造影的６８例分为冠心病组（４６例）和非冠心病组（２２例），分析其冠脉病变特点并将危险因素加以对照。结果：前降支受累率最高，为７６％；男性患者中，多支病变者多于女性（Ｐ＜０．０５），冠脉病变积分高于女性（１１．８２±５．４４ｖｓ．７．１０±３．１５，Ｐ＜０．０５）。冠心病家族史和血胆固醇水平为冠心病的主要危险因素，比值比分别为３．９８（９５％可信区间１．３８～１１．５１），２．０９（９５％可信区间１．２６～３．４６）。冠脉病变积分与男性、胆固醇水平呈正相关，相关系数分别为０．３６６和０．３５４，Ｐ均＜０．０５。结论：冠脉病变男性重于女性，青年冠心病患者的冠心病家族史是不可忽视的重要危险因素。     

1264例选择性冠状动脉造影的分析

我院１２６４例（男９７６例，女２８８例）选择性冠状动脉造影结果显示：冠状动脉造影确诊冠心病（ＣＡＤ）５６１例，阳性率４４．４％，其中男性４８５例，占男性人数的５０％，女性７６例，占女性人数的２６％。血管受累依次为前降支、三支血管病变（二支血管病变加左主干病变包括在内），二支血管病变，单支右冠，单支回旋支。冠状动脉造影还应用于非冠心病心脏手术前，如瓣膜病、夹层动脉瘤、先天性心脏病疑有冠脉异常者，以及发现冠脉发育或走行异常等。     

老年冠心病患者经皮冠状动脉腔内成形术结果评价

目的评价一组老年冠心病患者行经皮冠状动脉腔内成形术（ＰＴＣＡ）的疗效。方法将６５例老年（８９支血管）和１１７例老年前期（１４９支血管）冠心病患者的ＰＴＣＡ结果作对比研究。结果老年组血管扩张成功率９４．４％，临床成功率９２．３％，主要并发症发生率为６．１％，再狭窄发生率为３２．５％。以上结果与老年前期组比较差异均无显著性。术后症状改善率两组相同，都在９０．０％以上。仅老年组再次ＰＴＣＡ频率明显高于老年前期组（ｘ２检验，Ｐ值＜０．０５）。结论对于老年冠心病患者，ＰＴＣＡ是一种有效及安全的冠脉血管重建措施。     

冠心病患者纤溶活性、血小板功能及内皮素在运动前后的变化及其临床意义

目的研究冠心病患者在运动前后纤溶活性、血小板活化状态及血管内皮功能的变化。方法根据冠状动脉造影结果，选择冠心病患者（ＣＨＤ组）３７例，分为单支及多支病变组；另选健康人２７例为对照组（Ｃ组）。采用次极量运动试验观察上述部分指标在运动前后的变化。结果（１）运动前，组织型纤溶酶原激活剂（ｔＰＡ）、纤溶酶原激活剂抑制因子１（ＰＡＩ１）活性、血浆５羟色胺（５ＨＴ）水平及血小板５ＨＴ２Ａ受体密度，ＣＨＤ组均高于Ｃ组（Ｐ＜０．０５）；血浆内皮素（ＥＴ）１浓度两组差异无显著性（Ｐ＞０．０５）。（２）运动后，ＣＨＤ组ｔＰＡ活性下降（Ｐ＜０．０５），ＰＡＩ１活性上升（Ｐ＜０．０２５）；血浆５ＨＴ水平及血小板５ＨＴ２Ａ受体密度增加（Ｐ＜０．０５）；血浆ＥＴ１浓度上升，与Ｃ组比较差异有显著性（Ｐ＜０．０５）。上述各指标的增高，多支病变组较单支病变组明显（Ｐ＜０．０１～０．００５）。（３）运动前仅ＰＡＩ１活性与心肌缺血面积呈正相关（ｒ＝０．４５２，Ｐ＜０．００５）。结论冠心病患者纤溶活性下降，血小板激活，血管内皮受损，使冠心病患者易发生冠状动脉痉挛及血栓形成。次极量运动使之进一步加重而易诱发冠心病事件。     

不稳定性心绞痛临床与冠状动脉造影分析

为了解不同类型不稳定性心绞痛的冠状动脉（冠脉）造影特点，对３８８例不稳定性心绞痛患者进行临床及冠脉造影对照分析。结果表明：初发劳力型心绞痛单支血管病变占６９．６４％，较其他各型多见（Ｐ＜０．０５）；静息型心绞痛三支血管病变和左主干病变较其他各型多见（Ｐ＜０．０５），复杂性病变和Ｃ型病变检出率也较其他各型高（Ｐ＜０．０５）；恶化劳力型心绞痛病变特征介于上述二者之间；梗塞后早期心绞痛“罪犯”病变多为次全闭塞或完全闭塞，较其他各型多见（Ｐ＜０．０５）；变异型心绞痛多半仅有轻度冠脉狭窄；梗塞后早期心绞痛血栓比初发、恶化型多见（Ｐ＜０．０５）。提示静息时心绞痛发作者病变更严重，应予积极治疗，对梗塞后早期心绞痛患者应加强抗凝治疗。     

去纤酶、764－3和肝素对血管成形术后平滑肌细胞增殖影响的实验研究

目的：探讨腔内血管成形术（ＴＡ）后再狭窄的预防。方法：将形成实验性粥样硬化狭窄的４６支兔髂动脉随机分为４组：去纤酶组（０．３ＩＵ·ｋｇ－１／ｄ，静脉注射×７日，ｎ＝１０），７６４－３组（２０ｍｇ·ｋｇ￣（－１）／ｄ，肌肉注射×３０日，ｎ＝１２），肝素组（７００ＩＵ·ｋｇ￣（－１）／ｄ，皮下注射×３０日，ｎ＝１２）和对照组（ｎ＝１２）。ＴＡ后３０天进行血管造影和病理形态学检查。结果：①去纤酶组髂动脉内膜厚度（０．１３±０．０３ｍｍ）显著小于７６４－３组（０．２６±０．１３ｍｍ）、肝素组（０．２９±０．１８ｍｍ）和对照组（０．３４±０．１３ｍｍ），Ｐ均＜０．０５。②ＴＡ后再狭窄率去纤酶组（０％）和７６４－３组（３３％）显著低于肝素组（６７％）和对照组（８３％），Ｐ均＜０．０５．③去纤酶组和７６４－３组内膜合成型平滑肌细胞较肝素组和对照组少。结论：去纤酶和７６４－３有抑制ＴＡ后血管平滑肌细胞增生，减轻内膜增厚，降低再狭窄发生率的作用。     

胆汁刀豆球蛋白A（ConA）结合蛋白在胆固醇性结石早期形成阶段的作用：胆汁ConA结合蛋白量与质分析

为了解胆固醇结石患者胆汁ＣｏｎＡ结合蛋白（ＣＰｓ）量与质的异常，应用亲和层析等方法对胆固醇结石、色素性结石及胆囊胆固醇息肉等患者的胆汁Ｃｐｓ进行了定量，并对不同个体的Ｃｐｓ与模拟胆汁泡相结合量及成核影响进行了比较。结果：色素结石（ｎ＝７）及非胆石患者（ｎ＝１０）胆汁ＣＰｓ浓度分别为０．２６±０．１２ｇ／Ｌ和０．２７±０．０９ｇ／Ｌ明显低于胆固醇结石患者（ｎ＝３６）的０．３９±０．１１ｇ／Ｌ（Ｐ＜０．０１）和胆固醇息肉患者（ｎ＝９）的０．４０±０．０９ｇ／Ｌ（Ｐ＜０．０１）；色素结石（ｎ＝５）及非胆石患者（ｎ＝２５）的成核活性（成核时间比）分别为０．７１±０．１９和０．７３±０．１１，也明显弱于胆固醇结石患者（ｎ＝２５）的０．５７±０．２１（Ｐ＜０．０１）和胆囊胆固醇息肉患者（ｎ＝５）的０．４４±０．２３（Ｐ＜０．０１）；胆固醇结石患者（ｎ＝２６）的ＣＰｓ与泡相结合量显著高于色素性结石患者（ｎ＝６）（２．４±０．９％比０．９±０．５％，Ｐ＜０．０１）。总结认为：胆汁ＣＰｓ量的升高及促成核活性增强，尤其是亲泡相ＣＰｓ的增加是胆固醇结石形成的重要原因。     

冠状动脉内支架再狭窄的多因素回归分析

目的分析与冠状动脉内支架再狭窄有关的临床和血管造影及其处理因素。方法回顾性分析了在我院成功冠状动脉内支架置入和６个月后有冠状动脉造影随访的７４例病人的临床和血管造影及处理资料。用单因素和多因素回归分析方法分析了病人年龄、冠心病易患因素、靶病变形态学、及术后最小管腔开放直径（ＭＬＤ）等３２个变量与再狭窄的关系。结果在单因素分析中发现：术前血管参照直径和术后ＭＬＤ在再狭窄组明显低于非再狭窄组（３．１±０．３ｍｍｖｓ３．３±０．４ｍｍ和２．９±０．４ｖｓ３．２±０．４ｍｍ（Ｐ＜０．０５和０．０１）。支架直径小于３．５ｍｍ组的再狭窄率明显高于支架直径大于３．５ｍｍ组的再狭窄率（４１．７％ｖｓ１０．８％，Ｐ＜０．０５）。多元Ｌｏｇｉｓｔｉｃ回归分析发现：术后支架管腔ＭＬＤ、支架直径＜３．５ｍｍ、吸烟和高龄是再狭窄的独立危险因素。结论术后支架管腔ＭＬＤ、支架直径＜３．５ｍｍ、吸烟和高龄是最重要的支架再狭窄的独立危险因素     

曲美他嗪对猪心脏再灌注性心律失常的治疗作用

为研究曲美他嗪（ｔｒｉｍｅｔａｚｉｄｉｎｅ）对猪心脏再灌注性心律失常的治疗作用，我们采用两组在体猪心脏（对照组ｎ＝９，用药组ｎ＝１０）左冠状动脉前降支（ＬＤＡＣＡ）完全阻断１０分钟，再灌５分钟，重复３次。结果显示：对照组心室纤颤（ＶＦ）发生率三次分别为８９％、６７％、３０％（Ｐ＜０．０１），ＶＦ潜伏期分别为１４．５±１．４ｓ、１１９．８±１３．８ｓ、４８±１２．５ｓ（Ｐ＜０．０１）。用药组ＶＦ发生率三次分别为４０％、３０％、３０％、（Ｐ＞０．０５），ＶＦ潜伏期分别为１５．２±６．４ｓ，１２６．５±１８．６ｓ，９７±２３．４ｓ（Ｐ＜０．０１）。曲美他嗪对猪心脏再灌性ＶＦ有一定的减少作用。     

持续灌流法经皮冠状动脉球囊成形术治疗老年人心肌梗塞的临床价值

对比分析了老年急性心肌梗塞（ＡＭＩ）患者行持续灌流法冠状动脉球囊成形术（ＣＰＰＴＣＡ）２０例（３６支）和常规冠状动脉球囊成形术（ＰＴＣＡ）１８例（２４支）的疗效。两组患者术前冠状动脉狭窄的严重程度及左心室功能相似（Ｐ＞０．０５）。与ＰＴＣＡ组比较，ＣＰＰＴＣＡ对术中阻断血流的心肌有重要保护作用，且术中并发症少（０比３８．９％，Ｐ＜０．０１），残余狭窄轻（１２％±８％比２８％±１８％，Ｐ＜０．０５），再狭窄率（０比２２％，Ｐ＜０．０５），再梗塞率（５％比３３％，Ｐ＜０．０５）及病死率（０比２２％，Ｐ＜０．０５）低。     

Results (>6 months) of stenting of >1 major coronary artery in multivessel coronary artery disease.

Multivessel percutaneous transluminal coronary angioplasty (PTCA) is associated with a high requirement for further revascularization procedures. Although stenting can reduce restenosis and clinical events after 1-vessel intervention, little information is available after multivessel coronary stenting. We followed up 136 patients (9% of 1,481 undergoing stenting in our center) who had had stent implantation in at least 2 different major native coronary arteries and were followed-up for >6 months. Each patient had received a mean of 2.3 +/- 0.6 stents (1.13 +/- 0.4 stents per lesion) and procedural success was 95%. In-hospital complications included 1 death, 1 Q-wave infarction, 5 non-Q-wave myocardial infarctions, and 1 repeat PTCA. After a mean of 18 +/- 13 months, 7 patients died (3 of heart failure, 4 of noncardiac causes), 2 required coronary bypass surgery, 1 had a myocardial infarction, 13 target vessel repeat PTCA, and 4 non-target vessel PTCA. Survival free of major cardiac events was 75% at 3 years. A history of heart failure, dilation of a restenotic lesion, and 3-vessel dilation were independent negative predictors of event-free survival. Angiographic follow-up was available in 86 patients: 56 (65%) were restenosis free, 23 (27%) had 1-vessel restenosis, and 6 (7%) had 2-vessel and 1 patient 3-vessel restenosis. Restenosis per vessel was 23% (41 of 177). Reference diameter, past-PTCA minimal luminal diameter, and length of the stent were independent predictors of restenosis. We conclude that multivessel stenting provides good midterm results in selected patients with multivessel coronary artery disease. Midterm events are less frequent than previously reported after balloon PTCA.     

Provisional stenting for multivessel PCI

Background: Bare stents reduce acute complications and repeat revascularization following percutaneous coronary intervention (PCI), but are costly and may lead to in‐stent restenosis. It remains unclear whether stents should be universally implanted or whether provisional stenting mainly to suboptimal balloon dilatation results is an acceptable approach for multivessel PCI. Objective: To compare the long‐term clinical restenosis and target lesion revascularization (TLR) of stented and non‐stented coronary artery lesions in patients who had multivessel PCI. Methods: We performed retrospective analysis of matched data from 129 consecutive patients who underwent multivessel PCI (at least optimal balloon angioplasty to one coronary artery segment and balloon angioplasty plus stenting to another coronary artery in the same patient, all lesions are de novo native coronary artery lesions with vessel diameter ?2.5?mm). The study endpoint was restenosis and repeat revascularization at one‐year follow‐up. Results: Baseline characteristics were similar in both groups. Low in‐hospital MACE (3.1%). Acute myocardial infarction, emergency revascularization via either PCI or CABG was detected and angiographic success was achieved in 99.3% of lesions in both groups. The rate of clinically driven angiographic restenosis and TLR at one‐year (follow‐up?100%) was similar (17.1% versus 18.6%, P?=?0.871, and 13.9% versus 16.3%, P?=?0.728, for optimal balloon angioplasty versus provisional stenting. Conclusions: The main findings from this study are that long‐term angiographic restenosis and TLR was comparable for optimal balloon angioplasty and provisional stenting, suggesting that provisional stenting is an acceptable approach for multivessel PCI.     

切割球囊临床应用的有效性和安全性评价

目的 探讨切割球囊临床应用的安全性和有效性。方法 对131例患者142处狭窄病变进行切割球囊或切割球囊＋支架治疗。结果 142处狭窄病变行切割球囊治疗中4次失败，成功率为97.2%。切割球囊治疗支架内再狭窄、开口部病变、分叉病变和小血管弥漫性病变以及其他类型病变各为69处、16处、19处、7处和27处，7例切割球囊扩张后发生内膜撕裂，均为A型夹层，发生率为5.3%，术中无死亡和急性心肌梗死及其他严重血管并发症发生。失败原因与病变严重钙化以及切割球囊不能达到或通过狭窄部位有关。结论 切割球囊临床应用是安全面有效的。     

Outcomes of paclitaxel-eluting stent implantation in patients with stenosis of the left anterior descending coronary artery

OBJECTIVES: We sought to examine the efficacy of paclitaxel-eluting stent implantation in the left anterior descending coronary artery (LAD). BACKGROUND: Restenosis and recurrent cardiac events after percutaneous intervention are more common for lesions in the LAD than other native coronary arteries, and often necessitate bypass surgery. Drug-eluting stents may improve the long-term prognosis of this high-risk group. METHODS: In the TAXUS-IV trial, 1,314 patients with single de novo coronary lesions were assigned to implantation of the slow-release, polymer-based, paclitaxel-eluting TAXUS stent or an identical bare-metal stent; 536 (41%) randomized patients had LAD lesions. RESULTS: Baseline characteristics of patients with LAD lesions were well-matched between the randomized groups. Late lumen loss at nine months after paclitaxel-eluting and control stent implantation were 0.28 +/- 0.51 mm and 0.54 +/- 0.57 mm, respectively (p = 0.0004), and binary restenosis rates were 11.3% and 26.9%, respectively (p = 0.004). At one year, major adverse cardiac events (MACE) occurred in 13.5% of TAXUS-treated patients versus 21.2% treated with the control stent (p = 0.01). The need for bypass surgery at one year was reduced among patients randomized to the TAXUS stent (2.6% vs. 6.3%, p = 0.02). In the proximal LAD subgroup (n = 126), the one-year target vessel revascularization rate was 7.9% with the TAXUS stent and 18.6% with the bare-metal stent (p = 0.009). CONCLUSIONS: Compared to bare-metal stents, implantation of polymer-based, paclitaxel-eluting stents in LAD lesions is safe, and reduces angiographic restenosis and MACE one year. Notably, the need for bypass graft surgery due to restenosis is reduced after TAXUS stent implantation in LAD lesions.     

Procedural results and late clinical outcomes following multivessel coronary stenting

ObjectivesTo evaluate in-hospital and long-term clinical outcomes in a large consecutive series of patients undergoing percutaneous multivessel stent intervention.BackgroundHigh restenosis and recurrent angina rates have limited the clinical outcomes of multivessel coronary angioplasty before stents were available to improve angioplasty results.MethodsWe evaluated in-hospital and long-term clinical outcomes (death, Q-wave myocardial infarction [MI], and repeat revascularization rates at one year) in 398 consecutive patients treated with coronary stents in two (94% of patients) or three native arteries, compared to 1,941 patients undergoing stenting procedure in a single coronary artery between January 1, 1994 and August 29, 1997.ResultsOverall procedural success was obtained in 96% of patients with two- or three-vessel stenting and in 97% of patients with single-vessel stent intervention (p = 0.36). Procedural complications were also similar (3.8% for multivessel versus 2.9% for single vessel, p = 0.14). During follow up, target lesion revascularization was 15% in multivessel and 16% in single-vessel interventions (p = 0.38), and repeat revascularization (calculated per treated patient) was also similar for both groups (20% vs. 21%, p = 0.73). There was no difference in death (1.4% vs. 0.7%, p = 0.26), and Q-wave MI (1.2% vs. 0%, p = 0.02) was lower following multivessel interventions. Overall cardiac event-free survival was similar for both groups (p = 0.52).ConclusionsUnlike previous conventional angioplasty experiences, multivessel stenting has (1) similar in-hospital procedural success and major complication rates and (2) similar long-term (one year) clinical outcomes compared with single-vessel stenting. Thus, stents may be a viable therapeutic strategy in carefully selected patients with multivessel coronary disease.     

Clinical and angiographic outcome of NIR stent implantation in small vessels with unfavorable lesion morphology

BACKGROUND: Coronary artery stents are used for the treatment of acute or threatened vessel occlusion complicating coronary angioplasty or for the prevention of restenosis after angioplasty. Improvements in stent design made the stenting of complex and small vessels feasible. We prospectively evaluated the safety, efficacy and long-term patency of NIR stent (Boston Scientific, Maple Grove, Minnesota) implantation in small vessels with complex lesion morphology. METHODS: The study population consisted of patients with complex (type OCO) lesions under 3 mm vessel diameter who were undergoing coronary angioplasty for symptomatic coronary artery disease followed by high-pressure NIR stent implantation and antiplatelet therapy only. Follow-up angiography was performed six months after the initial procedure. RESULTS: Of 143 patients fulfilling the angiographic criteria and undergoing stent implantation between October 1995 and November 1997, 67 patients (46.9%) received NIR stents. In 58 patients (86.6%), angiographic 6-month follow-up was available. In one patient (1.7%), stent implantation was unsuccessful. Procedural success of the NIR stent implantation was 98.2%. Implantation of other stents failed in 12 cases. NIR stent implantation was successful in all of them. No patient required urgent bypass surgery. No patient died. Restenosis occurred 5.8 +/- 1.3 months after the initial procedure in 21 patients (36.2%). CONCLUSIONS: Coronary high-pressure stenting of small (< 3 mm) type OCO (AHA/ACC) lesions in patients with symptomatic coronary heart disease is a feasible treatment option with a high procedural success rate and low complication rate. The new flexible NIR stent showed an acceptable restenosis rate. The implantation was successful even in vessels in which previous attempts of Palmaz-Schatz stent placement had failed.     

Coronary stenting versus balloon angioplasty in small coronary artery with complex lesions.

The impact of stenting on small vessels (< 3.0 mm) with complex lesions (B2-C) is still controversial. Restenosis rate in this population is high (> 40%). We compared early and late outcome of patients with complex coronary lesions in small vessel treated with traditional coronary angioplasty (angioplasty group) and with elective stent implantation (stent group). Angioplasty group (n = 97) and stent group (n = 112) were comparable for all clinical and angiographic characteristics. All patients in the two groups had clinical and angiographic follow-up. Major adverse cardiac events (MACE) and restenosis rate were evaluated. No patients in the two groups experienced in-hospital death or bypass surgery. Myocardial infarction occurred in four patients in the angioplasty group and in seven patients in the stent group (P = 0.36). No patients in either the angioplasty or the stent group had acute stent thrombosis, whereas subacute stent thrombosis occurred in only one patients of the stent group (0.9%). Long-term MACEs (20 +/- 4 month) were not different in the two groups (angioplasty group 39% vs. stent group 44%, P = 0.35). Target lesion revascularization rate was 33% in the angioplasty group and 34% in the stent group (P = 0.50). Restenosis rate was not statistically different in the two groups (stent group 41% vs. angioplasty group 38%, P = 0.41). In conclusion, compared to balloon angioplasty, elective stent implantation in small vessels with complex lesions does not improve early and late outcome. Cathet. Cardiovasc. Intervent. 50:390-397, 2000.     

Pressure wire guide provisional coronary stent implantation

OBJECTIVES: Whether coronary artery lesion successfully dilated by balloon angioplasty should be stented or not is unclear. The purpose of this study is to evaluate the provisional stent implantation method assessing residual ischemia by pressure wire. METHODS: Thirty-one patients with de-novo lesions suitable for stenting were enrolled in a pressure wire guided provisional stent study. The pressure wire was used to assess the fractional flow reserve(FFR) before and after balloon angioplasty. When the FFR after angioplasty was less than 0.75, stent implantation was planned. Patients with lesions consisting of an intermediate stenosis proximal to the target lesion, chronic total occlusion, bypass graft and left main lesion were excluded from the study. Stent implantation was permitted even if the FFR was more than 0.75 when the operator thought stenting was necessary. Medical treatment was given with aspirin 162 mg/day, cilostazol 200 mg/day for 6 months and additional ticlopidine 200 mg/day for a month after stenting the lesion. RESULTS: Target vessel was the left anterior descending coronary artery in 19 lesions, the right coronary artery in 3, and the circumflex coronary artery in 9. Stent implantation was performed in seven (23%) of 31 lesions and the other 24(77%) lesions were treated with only balloon angioplasty. The FFR before intervention was 0.58 +/- 0.16, and improved to 0.87 +/- 0.07 (p < 0.0001). Percentage diameter stenosis before intervention was 70.7 +/- 12.6% and improved to 20.1 +/- 13.3% (p < 0.0001) after intervention. There was no major cardiac event (death, coronary artery bypass grafting, myocardial infarction, stent thrombosis). Six months follow-up angiography was performed in 27 patients (87%). Angiographic restenosis (percentage diameter stenosis > or = 50%) was found in four patients (15%). A new lesion was found in two patients. Target vessel revascularization was performed in six patients (21%). CONCLUSIONS: Lesions successfully dilated by balloon angioplasty with FFR > or = 0.75 do not require stenting.     

Angiographic outcome in multivessel disease (GABI II study) using new coronary device interventions and comparison with GABI I trial results

Percutaneous coronary interventions using stents were investigated in patients with multivessel disease. Acute and long-term results were compared with those of the German Angioplasty Bypass Surgery Investigation trial in a prospective multicenter study. The study included 134 patients in whom 277 lesions were treated. Angiographic success and procedural success were achieved in 268 of 277 lesions (97%) and 118 of 134 patients (88%), respectively. Control angiography performed in 90 of 118 eligible patients (76%) exhibited restenosis in 43 of 182 lesions (24%). Multivariate regression analysis found that a diffuse lesion, the lesion and stent length, and the final luminal diameter were predictive for restenosis. Thus, immediate and long-term results of multivessel coronary intervention utilizing stents were improved compared to percutaneous transluminal coronary angioplasty of multivessel lesions. However, there is still need for improvement of long-term results, especially in particular lesion subgroups.     

Dobutamin-Stre?echokardiographie zur Beurteilung des postinterventionellen Ergebnisses nach intrakoronarer Stentimplantation

Stress echocardiography has been shown to be a valuable noninvasive method for the diagnosis of restenosis after coronary angioplasty. To determine the usefulness of dobutamine stress echocardiography (DSE) for assessment of restenosis after intracoronary stent implantation, we studied 50 patients (59+/-10 years; 1-vessel disease, n=16; multivessel disease, n=34) after stent implantation. After 6 month, both DSE (5-40 mcg/kg/min, 0-1mg atropine) and angiography were performed within 48 hours and evaluated in a blinded fashion. Restenosis was defined by quantitative coronary angiography as minimal lumen diameter (LD) <50% of average reference LD. Diagnostic criteria of DSE were new or worsening wall motion abnormalities in corresponding perfusion territories during stress. Angiography revealed restenosis in 8 patients; one patient had a denovostenosis distal to the stented segment (8 x left anterior descending artery, 1 ACVB to the right coronary artery). In 6 of these 9 patients, DSE was positive (mean reduction of LD 88+/-7%; sensitivity 67%), in 3 patients negative (mean reduction of LD 62+/-7%, 1 x termination of DSE because of wall motion abnormalities in an area not supplied by the stented vessel). In 38 of 41 patients without restenosis, DSE showed no stress-induced wall motion abnormalities in the LV area supplied by the stented vessel (specificity 93%). CONCLUSIONS: DSE is a useful noninvasive method for detecting restenosis after intracoronary stent implantation. With negative DSE at follow-up, a functionally relevant stent restenosis is highly unlikely.