药物洗脱支架治疗冠状动脉小血管病变的疗效分析

目的 通过分析比较裸金属支架（BMS）与药物洗脱支架[DES，包括雷帕霉素（Cypher）支架和紫杉醇（TAXUS）支架]治疗冠状动脉小血管病变疗效的差异，为DES治疗多支及单支小血管病变冠心病提供依据。方法连续入选2002年12月至2005年5月沈阳军区总医院首次接受经皮冠状动脉介入治疗（PCI）、靶血管为小血管病变且达到完全血运重建的486例患者，其中多支小血管病变（多支）150例。分为BMS组214例（多支63例）、Cypher组140例（多支46例）和TAXUS组132例（多支41例），对比分析各组患者住院期间及随访6个月的临床情况。结果3组患者冠脉病变特点、PCI成功率及住院期间主要不良心脏事件（MACE）发生率等指标差异均无显著性（P〉0．05）。冠脉造影随访显示，两个DES组再狭窄率均明显低于BMS（Cypher组4．9％，TAXUS组7．5％对BMS组29．2％，P〈0．05），随访期间MACE发生率亦明显低于BMS（Cypher组2．9％，TAXUS组3．9％对BMS组12、0％，P〈0．01）。进一步分析多支小血管病例，发现两个DES组的再狭窄率及随访期间MACE发生率仍然明显低于BMS组（再狭窄率Cypher组6．7％，TAXUS组7．1％对BMS组37．5％，P〈0．05；MACE发生率Cypher组4、1％。TAXUS组4．8％对BMS组21．O％，P〈0．05）。结论Cypher和TAXUS支架治疗小血管病变安全可行，疗效显著，治疗多支小血管病变可得到相同的疗效。     

药物洗脱支架对完全闭塞性病变介入治疗预后影响的评估

目的比较对于完全性闭塞病变采用药物洗脱支架和金属裸支架的近期和远期预后。方法选择我院近期连续接受置入药物洗脱支架(DES)或金属裸支架(BMS)治疗,并且进行冠状动脉造影随访的155例存在完全闭塞病变的冠心病患者。患者在支架术后6个月左右接受冠状动脉造影随访。结果共155例患者(138名男性,17名女性)159处靶病变置入232枚支架完成造影随访,其中慢性完全性闭塞65例,占41.9%。其中C型病变占总数的85.4%。在患者基本条件方面,DES组2型糖尿病比例要多于BMS组(33.8%比18.5%,P=0.030)。在病变基本条件方面,DES组和BMS组C型病变分别占89.6%和72.0%(P=0.005),DES组病变更为复杂。DES组慢性完全闭塞病变比例明显高于BMS组(60.3%比24.4%,P<0.001)。DES组和BMS组的支架长度和病变长度没有差别。DES组参考血管直径小于BMS组[(2.72±0.36)mm比(2.96±0.52)mm,P=0.001]。6个月随访结果显示支架再狭窄DES组明显低于BMS组(15.6%比41.5%,P<0.001)。DES组支架再狭窄更多为局限性(58.3%比17.6%,P<0.001)。DES组的靶病变血管重建率明显低于BMS组(5.8%比19.9%,P=0.001)。病变内晚期腔径丢失DES明显小于BMS[(0.36±0.63)mm比(1.04±0.70)mm,P<0.001]。晚期支架内血栓DES有2例,BMS为0。DES组有1例死亡。术后主要心脏不良事件发生率两组分别是1.4%和11.1%,DES组显著低于BMS组(P=0.032)。结论我们的研究发现对于完全闭塞性病变的治疗,DES有着良好的治疗效果,比BMS有着明显减低的再狭窄率、靶病变血管重建率,并且在随访期间患者有着更少的心血管事件。     

药物洗脱支架和金属裸支架治疗弥漫病变的比较研究

目的比较冠心病患者弥漫病变采用药物洗脱支架和金属裸支架治疗的近期和远期预后,分析影响这类病变介入治疗预后的危险因素。方法研究对象为我院2004年4月至2005年8月接受置入单个长度>25.0mm支架治疗并且进行冠状动脉造影随访的205例患者,排除支架置入失败及支架置入位置不理想者。分为置入药物洗脱支架(DES)组(n=128)和置入金属裸支架(BMS)组(n=77)。所有的患者术后均接受阿司匹林300mg、氯吡格雷75mg等规范药物治疗。手术成功判定标准为至少用相互垂直的两个投照体位行冠状动脉造影,肉眼判定残余狭窄<20%和前向血流TIMI3级。再狭窄判定标准以复查冠状动脉造影定量分析支架内或支架邻近血管管腔直径狭窄程度≥50%。患者在支架术后6个月左右接受冠状动脉造影随访。结果共205例患者(男性181例,女性24例)227个靶病变置入382枚支架完成造影随访。其中C型病变占总数的93.8%,B2型病变为6.2%。双支或双支以上血管病变的患者比例达到86.8%。平均术前参考血管直径(2.88±0.43)mm。平均每个病变支架长度(40.09±12.94)mm,54.2%的病变接受了重叠置入支架。比较置入DES组和置入BMS组,两组的患者基本条件差异无统计学意义,在病变基本条件方面,DES组术前参考血管直径明显小于BMS组[(2.80±0.37)mm比(3.10±0.48)mm,P=0.005]。6个月随访结果显示再狭窄率DES组(15.4%)小于BMS组(48.4%),P<0.001。晚期支架内腔径丢失BMS组明显大于DES组[(0.94±0.76)mm比(0.39±0.53)mm,P<0.001]。靶病变血管重建率DES要明显好于BMS(11.6%比38.5%,P<0.001)。支架内再狭窄在置入DES组的局限性再狭窄比例大于置入BMS组(33.3%比18.2%,P=0.029)。对影响复杂弥漫病变支架再狭窄因素的多元logistic回归分析发现,采用支架重叠置入(OR=2.82,P=0.017)和支架类型(OR=5.71,P<0.001)是对复杂弥漫病变支架内再狭窄影响最大的危险因素。结论我们的研究发现对于复杂弥漫病变的治疗,药物洗脱支架有着良好的治疗效果,较金属裸支架能明显减低再狭窄率。对于弥漫病变,我们应该使用长支架,尽可能减少支架重叠置入的数量。     

联合应用不同类型的药物洗脱支架治疗多支冠状动脉病变

目的探讨联合应用不同类型的药物洗脱支架（DES）治疗多支冠状动脉病变的有效性和安全性。方法在进行多支或多处冠状动脉病变的介入治疗过程中,不同类型的DES（cypher和taxus）同时置人同一患者体内,并分为cypher组和taxus组,所有患者术后进行10个月临床和造影随访。结果34例患者入选,其中靶血管52支,靶病变68处,共置入支架75枚,其中cypher支架36枚、taxus39枚。术前两组狭窄程度分别为（75．4±14．2）％和（76．9±18．2）％,病变长度为（13．5±9．4）mm和（10．9±4．7）mm（P均〉0．05）。置入支架直径cypher组低于taxus组[（2．6±0．3）mm比（2．8±0．4）mm,P〈0．05]。支架长度分别为（16．8±6．3）mm和（16．0±6．3）mm（P〉0．05）。处理同一病变时,cypher和taxus两种支架重叠6例。对所有患者进行了平均（10±5）个月的临床随访,心脏事件（MACE）发生率为8．8％（3／34）。9例患者随访期间进行了冠状动脉造影,其中发生MACE的3例患者有2例发生支架内再狭窄（cypher和taxus组各1例）,另1例为其他部位新的病变。6例支架重叠的患者无MACE发生。结论对多支或多处冠状动脉病变的患者同期置入不同的DES是安全和有效的。     

冠心病患者药物洗脱支架植入术后球囊高压后扩张疗效观察

目的观察冠心病患者药物洗脱支架（DES）植入术后球囊高压后扩张的临床疗效。方法选择冠心病患者656例,其中332例（观察组）冠状动脉DES植入术后予非顺应性球囊高压后扩张,324例（对照组）仅行DES植入术,记录术中及术后情况。结果两组血管病变情况、血管病变数量、植入DES数量、支架植入后管腔狭窄程度、术中并发症比较,P均〉0．05。对照组支架植入后管腔最小直径为（2．74±0．32）mm、绝对内径获得为（2．25±0．40）mm,观察组分别为（3．13±0．34）、（2．63±0．47）mm,P均〈0．05;对照组术后随访亚急性支架内血栓发生率为1．54％、晚期支架内血栓发生率为1．85％,观察组分别为0．30％、0．30％,P均〈0．05。对照组术后12个月主要心脏不良事件发生率为6．79％、支架内再狭窄发生率为6．10％、支架最小内径为（2．37±0．38）mm、支架绝对内径丢失为（0．38±0．19）mm、管腔狭窄程度为18．70％±9．28％,观察组分别为2．41％、2．28％、（2．78±0．42）mm、（0．23±0．13）mm、13．50％±8．67％,P均〈0．05。结论冠心病患者DES植入术后行球囊高压后扩张治疗可明显减轻管腔狭窄、减少绝对内径丢失,主要心脏不良事件发生率和支架内再狭窄发生率也明显降低。     

冠心病合并糖尿病患者金属裸支架置入术后再狭窄的临床和造影预测因素

目的探讨冠心病合并糖尿病患者支架术后再狭窄发生的危险因素,建立冠心病合并糖尿病患者支架术后再狭窄发生概率的预测模型,为中国冠心病合并糖尿病患者药物洗脱支架的合理使用提供循证医学证据。方法分析我院2002-2004年1126例冠状动脉内非药物洗脱支架置入术患者（2376处病变）,使用多元逻辑回归分析比较术后出现再狭窄组和无再狭窄组冠心病合并糖尿病患者临床数据和造影资料,并使用上述数据库建立支架术后再狭窄发生概率预测表。结果在889例（78．9％）有6个月随访冠状动脉造影资料的患者中,151例（17％）有糖尿病。再狭窄定义为支架内及前后5mm范围内狭窄≥50％参考管腔直径。在非糖尿病组（738例）,再狭窄的发生率为21．2％,糖尿病组（151例）再狭窄的发生率为35．9％（P〈0．001）。多元逻辑分析结果显示参考血管直径（≤3．0mm）,病变长度（〉15mm）和胰岛素治疗是冠心病合并糖尿病患者术后再狭窄的可预见危险因素（P〈0．05）。支架术后再狭窄发生概率的预测表结果显示冠心病合并糖尿病患者再狭窄发生概率首要依赖于参考血管直径。结论冠心病合并糖尿病患者支架术后再狭窄发生概率显著增加。参考血管直径、病变长度和需要胰岛素治疗是冠心病合并糖尿病患者支架术后再狭窄的可预见危险因素。非糖尿病患者合并短病变（〈15mm）而无论参考血管直径,糖尿病患者合并冠状动脉大直径血管（〉3．0mm）合并短病变（〈15mm）预期再狭窄发生率〈15％,可以考虑使用金属裸支架。除此之外,建议使用药物洗脱支架。     

雷帕霉素药物支架治疗冠心病的远期疗效

目的 评价雷帕霉素药物洗脱支架（Firebird^TM）在冠心病患者介入治疗中的疗效及其安全性。方法 药物支架组患者接受Firebird^TM支架治疗的老年冠心病患者52例（72枚），普通支架组为选择同期接受普通冠状动脉支架治疗的冠心病患者43例（53枚），比较两组的临床特征、支架置入情况及临床事件发生率。结果 药物支架组中的糖尿病患者占46．2％，明显高于普通支架组（34．9％，P〈0．05）；干预的病变血管呈弥漫性病变，药物支架组占40．9％，高于普通支架组（28.3％，P〈0．05）；病变血管平均参考内径，药物支架组为（2．63±0．23）mm，普通支架组为（3．12±0．17）mm，差异有统计学意义（P〈0．05）；置入支架内径和长度，药物支架组分别为（2．75±0．22）mm和（23．1±4．0）mm，普通支架组分别为（3．05±0．19）mm和（15．6±3．3）m，差异有统计学意义（P〈0．05）。随访12～18个月，心绞痛复发率，药物支架组3．8％，普通支架组16．3％；靶病变血管再次血运重建率，药物支架组0，普通支架组9．3％，P〈0．05）。结论 Firebird^TM支架治疗冠心病安全有效，对冠状动脉弥漫性病变、小血管病变的也有较好的疗效。其近期及远期临床效果均优于普通支架。     

冠心病多支病变支架植入与冠脉旁路移植术疗效的比较

目的：比较老年冠心病多支冠状动脉病变患者的雷帕霉素洗脱支架植入与冠状动脉旁路移植术近期与中期的疗效。方法：回顾性人选2001年12月至2005年12月，行择期血运重建的多支冠状动脉病变患者，分为冠状动脉旁路移植术组（CABG组，n=310），雷帕霉．素洗脱支架植入组（SES组，n=257）。随访包括死亡、心肌梗塞（MI）、卒中和再次血运重建的主要不良心脑血管事件（MACCE）。采用Kaplan-Meier方法估计无事件生存率。采用Logistic多元回归方法调整分析治疗对终点事件的相对影响。结果：随访率96．4％。中位随访时间24个月。随访30d，CABG组MACCE的发生率高于SES组（5．8％：1.5％，P〈0．05），CABG组的死亡率高于SES组（4．7％：1．4％，P〈0．05）。至随访结束，CABG组累积死亡率仍高于SES组（6．6％：2．9％，P〈0．05），但再次血运重建率低于SES组（1.6％：8．6％，P〈0．05），MACCE两组间无差异。结论：多支冠状动脉病变患者冠状动脉旁路移植术的死亡率高于雷帕霉素洗脱支架植入，中期血运重建率低于雷帕霉素洗脱支架植入。     

冠状动脉西罗莫司洗脱支架置入后晚期支架内血栓形成分析

目的分析冠状动脉药物洗脱支架置入后晚期支架内血栓形成的临床相关因素。方法回顾性分析2003年7月至2005年1月我院置入西罗莫司洗脱支架的1304例冠心病患者中发生晚期支架内血栓的8例患者的临床资料、冠状动脉病变特点、支架释放情况以及术后的抗血小板治疗等相关因素。结果8例患者平均年龄（51±10）岁、7例为急性冠状动脉综合征患者且伴有多项心血管病危险因素,仅1例患者伴有左室功能不全,无肾功能不全患者;多支冠状动脉病变患者6例且病变较复杂,包括闭塞、分叉、开口和弥漫长病变;支架释放压力平均（1175.37±167．19）kPa（11．60±1．65atm）,全部患者未用高压球囊进行后扩张;双重抗血小板治疗平均时间为（157．5±41．7）d,1例在停用氯吡格雷第7天、2例在服用阿司匹林和氯吡格雷治疗期间、5例停用氯吡格雷6个月后出现支架内血栓,平均血栓发生时间为术后（450．3±344．7）d,5例表现为急性心肌梗死;1例死亡,5例再次置入西罗莫司洗脱支架,术后随访无症状,1例药物治疗。结论发生晚期支架内血栓的冠心病患者多表现为急性冠状动脉综合征、伴有多项心血管病危险因素;多支、复杂冠状动脉病变;支架低压释放,置入后未行后扩张;双重抗血小板治疗时间短。发生晚期支架内血栓患者预后差,死亡率较高,再次置入西罗莫司洗脱支架是安全、有效的。     

西罗莫司洗脱支架与裸金属支架治疗冠心病多支病变的远期安全性比较

目的观察多支冠状动脉病变使用西罗莫司洗脱支架行血运重建的远期临床安全性。方法单中心回顾性病历复习，入选冠状动脉造影显示2支、3支冠状动脉病变或左主干病变的患者562例。根据置入支架的不同，分为药物洗脱支架（SES）组（251例）、裸金属支架（BMS）组（311例）。对两组患者出院后死亡和AMI事件进行随访分析。结果中位随访时间为19．4个月，随访率92．9％。血运重建1年后心性死亡SES组3例，BMS组1例；非致死性心肌梗死每组2例。上述事件的发生率两组间差异无统计学意义（2．3％比1．1％，P=NS）。Kaplan—Meier方法分析显示，出院后无心性死亡和非致死性心肌梗死事件生存率两组间差异无统计学意义（97．3％比97．2％，P=0．951）。结论研究显示，多支冠状动脉病变西罗莫司洗脱支架置入治疗与裸金属支架比较，远期心性死亡和AMI事件的发生率相似，提示远期支架内血栓形成率不增加。     

Comparison of effects of drug-eluting stents versus bare metal stents on plasma C-reactive protein levels

After coronary stenting, inflammatory mechanisms play a crucial role in the pathogenesis of neointimal proliferation and in-stent restenosis. Drug-eluting stents (DESs) have been shown to decrease in-stent restenosis in different studies. We compared plasma C-reactive protein (CRP) levels after DES implantation with levels after bare metal stent (BMS) implantation. We performed percutaneous coronary intervention with a single stent in 67 patients (54 men; 59 +/- 9 years of age; n = 21 in the BMS group, n = 46 in the DES group) who had stable angina. Plasma CRP levels were determined before intervention and at 48 hours, 72 hours, and 2 weeks after coronary stenting. There was no difference in clinical and angiographic baseline characteristics except that the DES group had more patients with diabetes (34.8% vs 9.5%, p = 0.04), smaller reference vessels (2.95 +/- 0.53 vs 3.29 +/- 0.53 mm, p = 0.02), and smaller stent diameters (3.0 +/- 0.4 mm vs 3.4 +/- 0.5 mm, p <0.01). Plasma CRP levels at 48 hours (13.4 +/- 14.7 vs 5.9 +/- 4.9 mg/L, p <0.01) and 72 hours (16.7 +/- 19.8 vs 5.4 +/- 3.9 mg/L, p <0.01) after stent implantation were significantly higher in the BMS than in the DES group. In conclusion, DESs showed significantly lower plasma CRP levels after coronary stenting compared with BMSs. This may reflect the potent effects of DESs on acute inflammatory reactions induced by coronary intervention.     

Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-Long trial)

To evaluate the impact of cilostazol on neointimal hyperplasia after drug-eluting stent (DES) implantation for long coronary lesions, we performed a randomized multicenter prospective study comparing triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n = 250) and dual antiplatelet therapy (aspirin and clopidogrel; standard group, n = 250) for 6 months in patients with long lesions (> or =25 mm) requiring a long DES (> or =32 mm). The primary end point was in-stent late loss at 6-month angiography. The 2 groups had similar baseline clinical and angiographic characteristics. In-stent late loss (0.22 +/- 0.48 mm vs 0.32 +/- 0.51 mm, p = 0.031) and in-segment late loss (0.34 +/- 0.49 mm vs 0.51 +/- 0.49 mm, p = 0.001) at 6-month follow-up angiography were significantly lower in the triple group versus the standard group. There was a trend toward lower rates of in-segment restenosis in the triple group versus the standard group (6.7% vs 11.2%, p = 0.104). Target lesion revascularization (TLR; 2.8% vs 6.8%, p = 0.036) and major adverse cardiac events (2.8% vs 7.6%, p = 0.016), including death, myocardial infarction, and TLR at 9 months were significantly lower in the triple group than in the standard group. At 9 months, the 2 groups had similar rates of stent thrombosis (0.4% vs 0.4%, p = 0.999), death (0% vs 0.8%, p = 0.499), and myocardial infarction (0.4% vs 0.4%, p = 0.999). In conclusion, cilostazol significantly reduced late loss at 6 months after DES implantation and the occurrence of TLR and major adverse cardiac events in patients with long coronary lesions.     

Clinical outcomes after heterogeneous overlap stenting with drug-eluting stents and bare-metal stents for de novo coronary artery narrowings

When it is difficult to deliver multiple drug-eluting stents (DES) or when size constraints limit DES implantation, bare-metal stents (BMS) may be implanted contiguous to DES. However, the clinical outcomes after overlapping DES and BMS implantation are not known. From September 2004 to June 2006, 4,872 consecutive patients who underwent percutaneous coronary intervention consented to be enrolled in a prospective registry. Of these patients, 44 (0.9%) with de novo lesions were treated with DES and BMS overlap stenting. All patients were followed to 12 months for the assessment of clinical outcomes. The average implanted stent diameter was 2.68 +/- 0.30 mm for DES and 2.35 +/- 0.38 mm for BMS. Overlapping BMS were implanted distal to DES in all but 1 case. One patient (2.3%) experienced acute stent thrombosis and died 2 days after the procedure. No other patient died or had a myocardial infarction during 12 months. The target vessel revascularization rate at 12 months, however, was 31.8%, mainly driven by diffuse in-stent restenosis in the BMS segments. In conclusion, the incidence of DES and BMS overlap stenting is rare in daily practice, but this procedure is associated with a high rate of target vessel revascularization.     

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.     

西罗莫司和紫杉醇洗脱支架治疗支架内再狭窄的临床近期及10个月疗效

目的比较西罗莫司洗脱支架（Cypher或Cypher select）和紫杉醇洗脱支架（TAXUS）治疗支架内再狭窄的临床近期及10个月疗效。方法自2002年12月至2005年3月,对253例支架内再狭窄的患者采用了药物洗脱支架（DES）治疗并完成了10个月的临床随访和冠状动脉造影复查。253例中男性218例,女性35例,年龄30～80岁,平均年龄57．2岁。结果253例（262处病变）中152例使用Cypher支架176个,101例使用TAXUS支架132个。使用的Cypher和TAXUS支架的平均直径分别为（2．96±0．27）mm和（3．05±0,35）mm,P=0．04,平均长度分别为（23.31±6．68）mm和（23．56±6．54）mm,P=0．745。支架内再狭窄表现为100％闭塞29处,≥90％狭窄143处,〈90％狭窄90处。病变类型为A、B1、B2和C型各为9处、45处、73处和135处。PCI的成功率两组均为100％,住院期间无死亡,Cypher组主要心脏不良事件（MACE）发生率为2．63％,TAXUS组为2．97％,P=0．872。10个月临床造影显示在Cypher支架和TAXUS支架组中造影再狭窄率分别为14．0％和29．4％,P=0．075,MACE发生率分别为6．7％和16．0％,P=0．031。结论应用Cypher和TAXUS支架治疗支架内再狭窄有良好的近期临床疗效,10个月疗效Cypher支架优于TAXUS支架。     

Drug-eluting stenting is superior to bare metal stenting in saphenous vein grafts.

This study compared the outcomes of percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) with drug-eluting stents (DES) with bare metal stents (BMS). PCI of degenerated SVG is associated with worse outcomes and high incidence of in-stent restenosis compared with PCI of native coronary arteries. There is a paucity of data on the outcomes of PCI of SVG with DES. Data from 223 consecutive patients who underwent PCI of SVG were imputed into a dedicated clinical database. We assessed the clinical outcomes at a mean follow-up of 9.1+/-2.1 months. A total of 139 patients underwent PCI of SVG with DES and 84 patients with BMS. The mean age of the SVG was 7.6+/-3.8 years in the DES group and 7.7+/-2.8 years in the BMS group (P=0.38). Procedural success was achieved in all patients except for one patient in the BMS group who underwent emergent coronary artery bypass graft surgery for SVG dissection. There were no other in-hospital cardiac events in both groups. There was one cardiac death in the DES group and three deaths in the BMS group (P=0.03). When compared to the BMS, PCI of SVG with DES was associated with a lower incidence of myocardial infarction (4.3% vs. 20.2%; P=0.04) and target vessel revascularization (10.1% vs. 36.9%; P=0.035). When compared with BMS, PCI of SVG with DES was associated with a lower incidence of death, myocardial infarction, and target vessel revascularization.     

Angiographic restenosis after myocardial bridge stenting

Data on restenosis after stent implantation in myocardial bridges (MB) are very limited. Six-month angiographic results for 12 symptomatic patients who underwent stent implantation for myocardial bridges were compared retrospectively with those of 39 patients who underwent direct stent implantation for de novo atherosclerotic lesions in the left anterior descending artery. Diameter stenosis decreased from 69 +/- 8% to 4 +/- 5% in the MB group and from 79 +/- 8% to 7 +/- 6% in the control group after stent deployment. Systolic narrowing was abolished in all patients with MB. In follow-up, quantitative angiography revealed late loss of 1.8 +/- 1.3 mm in the MB group and 0.9 +/- 0.9 mm in the control group (P = 0.025). The in-stent restenosis rate was also higher in the MB group compared to the control group (67% versus 28%; P = 0.037). Despite favorable immediate results, stent implantation in MBs may not be promising because of the higher in-stent restenosis rate compared to stenting in de novo atherosclerotic lesions.     

Clinical and angiographic follow‐up after coronary drug‐eluting and bare metal stent implantation. Do drug‐eluting stents hold the promise?

OBJECTIVES: To investigate the influence of drug-eluting stent (DES) implantation on clinical and angiographic restenosis. DESIGN: Registry study of data from the Swedish Coronary Angiography and Angioplasty Registry with a coronary angiographic substudy. SETTING: Multi-centre study. SUBJECTS: During October 2002 to May 2004 a total of 23 590 percutaneous coronary intervention (PCI) procedures were performed at 25 hospitals. After selection, to achieve comparable groups, a total of 5068 patients of whom 4111 had a bare metal stent (BMS) implanted and 957 had a DES implanted, remained. End-point in the registry follow-up was >50% diameter restenosis at clinically driven reangiography within 12 months after index PCI. The primary end-point in the angiographic substudy was late loss in patients' DES at 6-month angiographic follow-up. RESULTS: The rate of clinically driven restenosis, within 12 months, in patients receiving DES was less (3.9%) compared with those who received BMS (7.0%). In multivariate analysis the risk of clinical restenosis was one-third for DES compared with BMS (HR 0.36, 95% CI 0.25-0.52). In the angiographic substudy late loss was 0.07+/-0.53 mm (range -0.88 to 1.62). The amount of late loss was related to the presence of diabetes mellitus or not (0.19+/-0.45 mm vs. -0.12+/-0.58 mm), and lack of postdilatation of the stent or not (0.23+/-0.51 mm vs. -0.09+/-0.50 mm). CONCLUSIONS: The use of DES in the Swedish 'real world' is effective in reducing the clinically driven restenosis rate, when compared with patients with BMS treatment. In the angiographic follow-up the average late loss was as low as observed in recent randomized multi-centre trials.