国产雷帕霉素药物洗脱支架在冠心病介入治疗中疗效评价

目的:观察国产雷帕霉素药物洗脱支架在冠心病介入治疗中有效性及安全性。方法:2010年1月至2010年12月我院心血管内科收治并行国产雷帕霉素药物洗脱支架(Firebird支架)置入术患者124例,收治并行进口雷帕霉素药物洗脱支架(Cypher^TM支架)置入术患者167例,于不同支架置入患者中各随机选68例,命名为国产组与进口组。术后1年、5年分别随访两组,观察两组患者支架置入后在不同时间段不良心血管事件发生情况及冠脉造影复查结果。结果:两组患者不良事件比较,国产组术后1年随访结果与术后5年随访结果比较,差异无统计学意义(P0.05);进口组术后1年随访结果与术后5年随访结果比较,差异无统计学意义(P0.05);国产组术后5年随访结果与进口组术后5年随访结果比较,差异无统计学意义(P0.05)。两组患者冠脉造影复查结果比较,差异无统计学意义(P0.05)。结论:国产雷帕霉素药物洗脱支架在冠脉介入治疗中具有安全性和有效性,与进口雷帕霉素药物洗脱支架比较无明显差异,值得临床推广应用。     

MCP-1和VEGF与冠心病患者冠脉病变程度的关系及介入前后的变化和意义

目的:探讨单核细胞趋化蛋白1(MCP-1)和血管内皮生长因子VEGF与冠心痛患者冠脉病变程度的关系及介入前后的变化和意义.方法:选择经冠状动脉造影确诊的冠心痛患者105例,根据病变程度分为单支病变组(A组)、双支病变组(B组)和多支病变组(C组),同时选择经冠状动脉造影确诊的正常时照组35例(D组),采用双抗体夹心ELISA法洲定术前术后血清MCP-1和VEGF水平.结果:1.血清MCP-1水平测定结果冠心病组明显高于正常对照组,三支病变组高于双支病变组,双支病变组高于单支病变组,支架置入术后显著高于术前,差异均有统计学意义(P<0.01),对照组术前术后相比差异无统计学意义(P>0.05).2血清VEGF水平测定结果显示:冠心病组明显高于正常对照组,三支病变组高于双支病变组和单支病变组,差异均有统计学意义(P<0.01),双支病变组与单支病变组间差异无统计学意义(P>0.05),支架置入术后较术前显著降低(P<0.01),术后冠心病组与对照组相比差异无统计学意义(P>0.05),对照组术前术后差异无统计学意义(P>0.05).结论:冠心病患者血清MCP-1、VEGF水平与冠脉病变程度密切相关,介入治疗可影响冠心病患者血清MCP-1水平的升高和VEGF水平降低,监测血清中MCP-1和VEGF水平变化可了解治疗效果和炎症程度.     

血尿酸水平对ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术后长期预后的影响

目的:探讨血尿酸(SUA)水平对行急诊经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者长期预后的影响。方法:连续纳入2012年1月至2012年12月在我院诊断为STEMI并成功行急诊PCI的患者275例,按照入院时SUA水平三分位法将患者分成A组91例(低尿酸)、B组90例(中尿酸)、C组94例(高尿酸)。收集所有患者临床基线资料,包括吸烟史、既往病史、血液学指标及冠脉造影结果等,观察三组患者急诊PCI术后住院期间及术后6年随访期间主要不良心血管事件(MACE)的发生情况,logistic回归分析SUA水平对患者近期及长期预后的危险因素。结果:C组男性和心律失常病史比例明显高于A、B组(P0.05)。同时,三组患者AIP、Scr、BUN、SUA、APTT组间比较差异有统计学意义(P0.05)。C组患者三支血管病变比例明显高于A、B组,差异有统计学意义(P0.05)。三组患者住院期间心力衰竭、支架内血栓形成、总MACE比例组间比较差异有统计学意义(P0.05)。三组患者术后6年心力衰竭、心绞痛、支架内再狭窄/闭塞和总MACE比例组间比较差异有统计学意义(P0.05)。Logistic回归显示年龄、吸烟史、TC、SUA、血栓抽吸术、IABP应用是住院期间MACE发生的危险因素(P0.05),AIP、SUA、APTT、IABP应用是PCI术后6年随访期间MACE发生的危险因素(P0.05)。结论:成功行急诊PCI的STEMI患者,SUA水平是其近期及长期预后的独立危险因素,SUA水平升高者长期MACE发生率增加。     

有无心脏外科支持的经皮冠状动脉介入术病例特点及转归的比较分析

目的:分析有无心脏外科支持的经皮冠状动脉介入术(PCI)病例的特点及转归差异。方法:回顾性分析2308例行PCI术患者的病例资料,根据心脏外科支持情况分为支持组(2031例)、无支持组(277例),比较两组患者的基线资料、PCI术相关指标及主要不良心血管事件(MACE)的发生情况。结果:与支持组比较,无支持组患者的医疗费用明显增加,急诊PCI、危险因素中AMI病史、PCI史、疾病诊断中STEMI的比例明显降低,LVEF明显升高,差异均有统计学意义(P0.05)。支持组以三支及以上冠脉病变以及B、C型复杂病变形态多见,支架置入数、左主干病变比例明显增多,靶血管IVUS比例检查比例、术中总并发症发生率明显降低,与无支持组比较差异均有统计学意义(P0.05)。两组PCI术后MACE的发生率比较差异均无统计学意义(P0.05)。结论:有无心脏外科支持的PCI患者的临床特点存在较大差异,无心脏外科支持的PCI患者以急诊手术为主,且靶血管病变相对较轻。对于低风险病例实施PCI手术是安全可行的,具有较高成功率,预后尚可。     

早发冠心病患者的危险因素及冠脉病变特点研究

目的:探讨早发冠心病(PCAD)患者的危险因素及冠脉病变特点。方法:收集2014年8月至2015年2月北京安贞医院急诊科行冠状动脉造影的1000例患者为研究对象,根据冠状动脉造影结果和临床资料分为早发冠心病(PCAD)组(男55岁,女65岁,n=340)、晚发冠心病组(n=300)和对照组(非冠心病者,n=360)。对三组患者的临床资料进行统计学分析,采用logistic回归分析PCAD患者的危险因素,并比较PCAD组与晚发冠心病组的冠状动脉病变特点。结果:Logistic回归分析结果提示:吸烟、早发冠心病家族史、高血压病及2型糖尿病是PCAD的独立危险因素(P0.001)。PCAD组单支病变比例显著高于晚发冠心病组(P0.05);回旋支、右冠状动脉病变比例低于晚发冠心病组(P0.05)。结论:吸烟、早发冠心病家族史、高血压病及2型糖尿病是PCAD的独立危险因素。早发冠心病患者冠脉病变主要累及前降支,单支病变多于晚发冠心病患者。     

ST 段抬高心肌梗死靶血管长病变急诊介入治疗的安全性及疗效分析

目的:探讨ST段抬高急性心肌梗死(ST-elevation myocardial infarction,STEMI)患者靶血管长病变(病变>25 mm)急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的临床疗效及安全性。方法:回顾性收集2009年1月-2010年6月因STEMI就诊于沈阳军区总医院并急诊行PCI处理的患者442例,以靶病变长度分为两组,即≤25 mm为短病变组(n=235)和>25mm为长病变组(n=207),均急诊行PCI治疗,分析和比较两组患者术前的基线资料、术中资料及并发症的发生情况、辅助措施(临时起搏、IABP、血栓抽吸装置)应用情况,术后30天、2年电话或临床随访,记录主要不良心血管事件(major adverse cardiac events,MACE)的发生情况。结果:与短病变组比较,长病变组吸烟者更多(81.6%vs 62.6%,P=0.000);以三支病变偏多(34.8%vs 24.7%,P=0.037);多枚支架使用率更高(1.47±0.63 vs 1.04±0.28,P=0.000),平均支架总长度显著增加(29.80±7.02 mm vs 22.95±5.58mm,P=0.000),手术成功率、术中并发症及辅助措施应用情况比较差异无统计学意义(P>0.05),30天及2年随访MACE的发生率比较差异无统计学意义(P>0.05)。结论:与急诊PCI治疗的STEMI短病变患者对比,长病变患者虽然病变复杂,多枚支架使用率高,平均支架总长度增加,但术中并发症、30天、2年内MACE与短病变患者相当,提示在以药物洗脱支架为主的介入治疗时代,急诊PCI处理STEMI靶血管长病变具有良好的疗效及安全性。     

冠心病患者介入治疗前后血清IL-18、sCD40L 和hs-CRP 水平的 变化及其意义

目的:探讨冠心病患者血清白介素18(Interleukin-18,IL-18)、白细胞分化抗原40配体(CD40L)、及高敏C反应蛋白(hs-CRP)水平在经皮冠状动脉介入术治疗前后的变化和意义。方法:选择经冠状动脉造影确诊的冠心病患者85例,根据病变程度分为单支病变组(n=32)、双支病变组(n=28)和多支病变组(n=25),采用双抗体夹心ELISA法测定PCI术前术后血清IL-18、CD40L和hs-CRP水平。结果:血清IL-18水平测定结果:多支病变组高于双支病变组,双支病变组高于单支病变组;支架置入术后显著高于术前,差异均有统计学意义(P<0.01)。血清CD40L水平测定结果:多支病变组高于双支病变组和单支病变组,差异均有统计学意义(P<0.01),双支病变组与单支病变组间差异无统计学意义(P>0.05);支架置入术后较术前显著升高,差异有统计学意义(P<0.01)。血清hs-CRP水平测定结果:多支病变组高于双支病变组,双支病变组高于单支病变组;支架置入术后显著高于术前,差异均有统计学意义(P<0.01)。结论:冠心病患者血清IL-18、CD40L和hs-CRP与冠脉病变程度密切相关,介入治疗可使冠心病患者血清IL-18、CD40L和hs-CRP水平升高,监测血清中IL-18、CD40L和hs-CRP水平变化可了解治疗效果和炎症程度。     

药物洗脱支架植入术与冠状动脉旁路移植术治疗冠心病多支病变伴糖尿病患者的临床效果分析

目的:比较药物洗脱支架(DES)植入术及冠状动脉旁路移植术(CABG)治疗冠心病多支病变伴糖尿病患者的近期及远期临床疗效。方法:回顾性分析2014年1月~2016年10月在哈尔滨医科大学附属第一医院经冠状动脉造影证实为多支血管病变并伴有糖尿病的患者186例,根据血运重建方式的不同分为DES组及CABG组,随访50.5±14.3个月,观察两组患者住院期间及随访期主要不良心脑血管事件(包括非致死心肌梗死、脑卒中、再次血运重建、全因死亡)的发生情况。结果:在所有入选患者中,DES组有更多双支病变(P0.05),CABG组三支病变较多(P0.05),两组在完全血运重建方面无显著性差异(P0.05)。住院期间,CABG组死亡2例(2.3%),DES组死亡1例(1.0%),死亡率比较无统计学意义(P0.05)。两组均未出现非致死性心肌梗死、脑卒中、再次血运重建。出院后对186例入选患者随访,其中失访11例(DES组5例,CABG组6例)。随访期间CABG组发生非致死性心肌梗死1例(1.3%)、脑卒中6例(7.5%)、全因死亡10例(12.5%),DES组发生非致死性心肌梗死5例(5.3%)、脑卒中3例(3.2%)、全因死亡9例(9.5%),两组间比较差异无统计学意义(P0.05);而CABG组再次血运重建2例(2.5%),DES组15例(15.8%),两组比较差异具有统计学意义(P0.01)。结论:行DES置入术或CABG术治疗冠心病多支病变伴糖尿病患者,住院期间主要心脑血管不良事件发生率、远期非致死性心肌梗死、脑卒中、全因死亡发生情况均无显著性差异,但DES组再次血运重建率明显升高,可能与糖尿病患者较高的再狭窄率有关。     

线粒体偶联因子-6（CF6）与冠心病患者支架植入后内膜增生程度的关系

目的:研究冠心病不稳定型心绞痛患者支架植入术后CF6浓度变化与支架内膜增生程度的关系。方法:筛选符合入组条件的患者20例,入组患者于造影前、造影后即刻、支架植入术(Percutaneous coronary intervention,PCI)后即刻、术后1天、术后3天、术后7天、术后12个月后检测体内CF6的浓度,并于术后12个月行冠状动脉造影复查,用光学相干断层成像(Optical coherence tomography,OCT)检测内膜增生程度。结果:造影前和造影术后即刻患者血浆CF6水平没有明显差别(造影前CF6:215.65+14.39pg/m L,造影术后即刻CF6:216.75+14.40 pg/m L,P0.05)。PCI术后即刻血浆CF6浓度较造影前增高(231.75+13.2 pg/m L,P0.05),术后1天可达到高峰(262.4+14.06 pg/m L,P0.05),3天后有所下降(239.86+13.15 pg/m L,P0.05),但仍高于造影前水平,7天后可以恢复至造影前水平(222.4+15.06pg/m L,P0.05)。术后1年随访时,血浆CF6水平是221.05+14.82 pg/m L,平均内膜增生厚度为0.158+0.014mm,平均内膜面积为0.134+0.057 mm2,患者内膜增生厚度与支架植入1天后血浆CF6峰值呈正相关(r=0.819,P0.05)。内膜增生面积与PCI术后血浆CF6峰值水平正相关(r=0.729,P0.05)。结论:冠心病患者术后CF6浓度峰值越高,其支架内膜增生越厚。     

急性ST段抬高型心肌梗死患者血清Lp(a)、UA、GGT与冠状动脉病变和PCI术后主要心血管不良事件的关系研究

摘要 目的：探讨急性ST段抬高型心肌梗死（STEMI）患者血清脂蛋白(a)[Lp(a)]、尿酸（UA）、γ-谷氨酰转移酶（GGT）与冠状动脉病变和经皮冠状动脉介入治疗（PCI）术后主要心血管不良事件（MACE）的关系。方法：选取2019年1月～2022年7月安徽医科大学第二附属医院心血管内科收治的100例接受PCI术治疗的急性STEMI患者为STEMI组,根据Gensini积分将其分为非重度病变组56例和重度病变组44例,PCI术后随访3个月,根据是否发生MACE分为MACE亚组和非MACE亚组,另选取同期50名冠脉造影检查排除冠心病者为对照组。收集急性STEMI患者的临床资料,并检测血清Lp(a)、UA、GGT水平。分析急性STEMI患者血清Lp(a)、UA、GGT水平与Gensini评分的相关性及PCI术后MACE的影响因素。结果：与对照组比较,STEMI组血清Lp(a)、UA、GGT水平升高（P＜0.05）。重度病变组血清Lp(a)、UA、GGT水平高于非重度病变组（P＜0.05）。Spearman相关系数分析显示,急性STEMI患者血清Lp(a)、UA、GGT水平与Gensini评分呈正相关（P＜0.05）。随访3个月,100例急性STEMI患者PCI术后MACE发生率为21.00％（21/100）。多因素Logistic回归分析显示,年龄增加、KILLIP心功能分级≥Ⅲ级和Lp(a)、UA、GGT升高为PCI术后MACE的独立危险因素,左心室射血分数（LVEF）升高为独立保护因素（P＜0.05）。结论：急性STEMI患者血清Lp(a)、UA、GGT水平升高,与冠状动脉病变严重程度和PCI术后MACE密切相关,可能成为急性STEMI患者PCI术后MACE的辅助预测指标。     

A comparison of clinical outcomes of Chinese sirolimus-eluting stents versus foreign sirolimus-eluting stents for the treatment of coronary artery disease

Background

Chinese sirolimus-eluting stents (SES) have been widely used in recent years. However, the comparison of clinical outcomes between Chinese and foreign SES remains unknown.

Objectives

To compare the outcomes of Chinese SES (Firebird) with foreign SES (Cypher Select) in the treatment of patients undergoing percutaneous coronary intervention (PCI).

Methods

4000 consecutive patients treated with SESs from January 2008 to December 2009 were included in this study. Based on the differences of the stents, the patients were divided into a Chinese SES group (Firebird; n = 2008) and a foreign SES group (Cypher Select; n = 1992). Outcomes were monitored for 1 year. The primary clinical endpoint was major adverse cardiac events (MACE): a composite of death, non-fatal myocardial infarction (MI) and target-vessel revascularisation (TVR).

Results

No differences were observed in the incidence of MACE (17.8% vs. 18.6%, p = 0.514) and TVR rate (9.0% vs. 8.6%, p = 0.632) during 1-year follow-up.

Conclusions

Chinese SES and foreign SES have similar effects on 1-year clinical outcomes and safety.     

冠状动脉磁共振血管成像和CT对可疑冠心病患者心脏事件的预测价值的比较研究

摘要 目的：探讨与比较冠状动脉核磁共振(MR)血管成像和CT对可疑冠心病患者心脏事件的预测价值。方法：2018年4月到2020年10月选择在本院诊治的103例可疑冠心病患者作为研究对象,所有患者都给予冠状动脉MRI血管成像与64层螺旋CT冠状动脉成像检查,记录影像学特征。随访患者的预后并进行预测价值分析。结果：103例可疑冠心病患者随访到2021年4月1日,发生心血管不良终点事件23例(不良事件组),发生率为22.3%。不良事件组的MRI血管成像显示右冠状动脉血管长度与内径都低于非不良事件组(P<0.05)。不良事件组的CT显示斑块率、斑块性质等与非不良事件组对比差异有统计学意义(P<0.05),两组斑块位置对比差异无统计学意义(P>0.05)。多因素Cox回归分析显示斑块性质、斑块率、右冠状动脉血管长度与内径都为导致心血管不良终点事件的重要因素(P<0.05)。结论：冠状动脉MRI血管成像和CT都可有效预测可疑冠心病患者心脏事件发生情况,能满足临床诊断可疑冠心病与预测预后的要求。     

应用运动后踝臂指数评估冠心病冠脉病变程度的临床研究

目的:探讨运动后踝臂指数(ABI)与冠状动脉病变程度的相关性及对冠状动脉病变的预测价值。方法:选取2012年1月-2012年9月我院收治的冠心病行冠状动脉造影患者117例,根据造影结果分为正常组(38例)、轻中度病变组(45例)和严重病变组(34例),术前所有患者均行静息状态及运动后ABI检查。结果:轻中度病变组和重度病变组运动后ABI下降,各组间运动后ABI差异有显著性(P0.05)。由ROC曲线图可知,运动后ABI诊断冠心病及病变程度的准确性高于静息ABI诊断,差异具有统计学意义(P0.01)。结论:静息ABI和运动后ABI对冠心病均有诊断价值,运动后ABI诊断价值更高。静息下ABI和运动后ABI对冠状动脉严重病变有中等诊断价值,运动后ABI对冠状动脉严重病变诊断价值较高。     

Clinical and quantitative angiographic outcomes following elective implantation of the self-expanding Wallstent for longer coronary artery lesions--final results of the Wellstent native study

BACKGROUND: Implantation of short balloon-expandable stents provides superior clinical and angiographic outcome compared with balloon angioplasty in selected patients. The purpose of the Wellstent study was to evaluate the safety and efficacy of the self-expanding Wallstent combined with aspirin and ticlopidine in patients with stable or unstable angina related to a native coronary lesion up to 45 mm in length. METHODS: 105 patients (111 lesions) with stable (57%) or unstable (43%) angina were included in this prospective multicentre evaluation. Angiography before and after Wallstent implantation and at 6-month follow-up was analysed at the core lab using the CAAS 2 system. The primary end-point was incidence of major adverse cardiac events (MACE) at 30 days. Secondary end-points were angiographic outcome at 6 months and MACE at 6 months and 1 year. RESULTS: Acute procedural success (successful stent implantation with residual stenosis <20%) was achieved in 99%. Mean reference diameter was 3.18 +/- 0.66 mm, minimal luminal diameter was 1.00 +/- 0.50 mm pre- and 2.84 +/- 0.47 mm poststent (diameter stenosis 16 +/- 6%). The mean hospital stay was 2.2 days. At 30 days, 95% of patients were free of MACE. At 6 month and 1 year clinical follow-up, 75% and 71% of patients, respectively, remained free of MACE, the majority of which (19 of 30) were re-interventions at re-angiography. In 90% of eligible patients, MLD at follow-up was 1.65 +/- 0.75 mm (late loss 1.20 +/- 0.66 mm, loss index 0.66), diameter stenosis 42 +/- 15%, with a restenosis rate of 32%. Longer stents were associated with greater luminal loss (P = 0.001) and less-favourable clinical outcome. CONCLUSIONS: Wallstent implantation, combined with aspirin and ticlopidine, achieved excellent acute and 30 day clinical results in a heterogenous high-risk patient group. Clinical outcome at 6 months and 1 year remained good, and most adverse events were re-PTCA during follow-up angiography. The loss index of 0.66 and restenosis rate of 32%, related in part to the use of longer stents, emphasizes the continuing need for effective anti-proliferative therapy.     

PCI术后是否抗凝治疗的临床疗效比较

目的：研究PCI术后是否应用依诺肝素抗凝治疗对患者临床疗效的影响。方法：于2011年5月至2012年1月间,连续入选在我院行冠状动脉造影并置入了支架的患者158例,将符合标准的患者随机分为非抗凝组或抗凝组两组各79名。非抗凝组术后常规应用阿司匹林和氯吡格雷。抗凝组术后加用依诺肝素。对入选患者进行院内随访记录其主要心脏不良事件及出血事件。结果：支架植入成功率100%。术后抗凝组113处病变共置入支架135枚;非抗凝组109处病变置入支架115枚。院内随访：主要心脏不良事件和严重出血差异无统计学意义。小出血事件抗凝组多于非抗凝组（P=0.007）。结论：冠状动脉支架置入术后非抗凝治疗组缺血不良事件发生率较抗凝组无明显增加,小出血并发症明显减少。该研究结果表明,对PCI术无特殊并发症的患者术后无需常规抗凝治疗。     

心率减速力及连续心率减速力对冠心病心脏性猝死的预警价值

目的：通过心率减速力（DC）及连续心率减速力（DRs）检测技术对老年冠心病患者进行风险分层,探讨其对心脏性猝死的预警价值。方法：随机选择经冠状动脉造影（CAG）确诊为冠心病（CHD）的患者218例作为观察组,其中隐匿性CHD 55例,急性心肌梗死（AMI）56例,心绞痛（AP）53例,缺血性心力衰竭（IHF）54例。同期选取在本院进行健康体检者55例（对照组）,对各组患者行24 h动态心电图检查,应用软件系统分析并计算出DC值及DRs值进行统计分析。结果：CHD各亚组（AMI组、AP组、IHF组、隐匿性CHD组）的DC值及DRs值均明显降低,与正常组比较,差异有统计学意义（P < 0.01）;DC值与DRs值所提示CAD各亚组的危险分级明显高于正常组,差异有统计学意义（P < 0.01）;冠状动脉造影显示冠脉病变数量越多范围越大,病情越重,这与DC、DRs所提示CHD各亚组的危险分级相一致。结论：心率减速力和连续心率减速力能够测定分析迷走神经功能,对冠心病患者进行危险分级,对高危人群有较高的预警价值,可作为预警冠心病患者发生心脏性猝死的敏感指标。     

Use of "Cypher" sirolimus-eluting stents in coronary heart disease patients with different types of coronary arterial lesions

The purpose of our study was to assess the immediate and late results of treatment with Cypher drug-eluting stents (Cordis, Johnson & Johnson, USA) in patients with coronary heart disease (CHD). This was a prospective study that included 738 patients who had been implanted Cypher stents in May 2002 to March 2006. The patients' mean age was 56 +/- 9 years; there were 87% of males. The patients were randomly included into the study and they underwent coronary stenting in the routine laboratory setting. A control group comprised 162 patients who had undergone Velocity or Sonic nondrug-eluting stents of the same firm, which had the similar structure. The groups did not differ in clinical characteristics. 827 stenoses in the eluting stent group and 225 stenoses in the control group were subject to revascularization. The immediate cure rate was 95 and 94%, respectively. The total number of events (myocardial infarction, emergency coronary bypass surgery, subacute occlusion of a stented segment) was 2.3% in the eluting stent group and 2.4% in the control group. A repeated examination 1 year after surgery was made in 482 and 119 patients in the drug-eluting and nondrug-eluting groups, respectively. During the follow-up, one patient died of a extracardiac cause and 3 (0.6%) patients underwent coronary bypass surgery in the nondrug-eluting stent group; there were no deaths and 2 (1.6%) patients had coronary bypass surgery in the control group. In the eluting stent group, there were fewer cases of repeated endovascular procedures of target stenosis revascularization than in the control group (3.7% versus 11.7%; p < 0.0005). In the eluting stent group, the total number of unfavorable cardiovascular events was significantly less than that in the control group and it amounted to 3.3% as compared with 15.9% in the non-eluting stent group; p < 0.0005. Cardiovascular event-free survival was significantly higher in the eluting stent group: 92% versus 77% in the non-eluting stent group (p < 0.0005).     

Use of Rtrade mark stent in the percutaneous coronary intervention of coronary bifurcation lesions

BACKGROUND: Percutaneous Coronary Intervention (PCI) of coronary bifurcation lesion is technically quite demanding. It has been associated with a lower procedural success, higher rates of complication and restenosis. Side-branch occlusion and plaque shifting or 'snow plow' effect are not uncommon. Stenting of the main vessel may cause 'stent jail' of the side-branch. Modern stent design may allow passage of a balloon or stent into the side-branch through the struts of the stent placed in the main vessel. A newly developed 316 stainless steel tubular stent, the Rtrade mark stent is uniquely designed to provide flexibility, radial strength on deployment and conformability. Its large cell size facilitates PCI of bifurcation lesion. AIM: To assess the feasibility of R(trade mark) stent in the treatment of symptomatic patients with bifurcation coronary lesions. The main objective was to assess the ease of deployment, side-branch access and overall success of the R(trade mark) stent in this group of patients without any major adverse events. METHODS: Between December 1998 and September 2000 the R(trade mark) stent was used as a main stent in 28 consecutive patients with coronary bifurcation lesions, 46% of which had unstable angina. The mean age was 59 +/- 10 and 89% were male. Adjunctive medical therapy included clopidrogel, aspirin and intraprocedure heparin. Abciximab (ReoPro) was given to 9 patients. RESULTS: Successful stent deployment was achieved in all patients. Thirty-four R Stents and 16 other stents were used. Two patients had post-procedure rise in cardiac enzymes. There were no major adverse events at 30 days. LAD/D1 with LAD/diagonal was the target lesion in the majority of patients. Stenting of the side-branch was done in 18 and balloon dilatation in 9 patients. At 3-23 months (mean 11.8) follow-up, repeat angiography was done in 18 patients with restenosis in 4, two of them had repeat PCI and one had coronary artery bypass graft (CABG). CONCLUSION: Coronary bifurcation lesions are not uncommon. Current advances in stent technology offer a safe and effective revascularisation strategy for such complex lesions. The R(trade mark) stent appears to be a suitable device that provides good wall coverage, radial strength, conformability and easy side-branch access.