Coronary heart disease is one of the most important causes of death in human, and consumes vast medical resources. Percutaneous coronary intervention (PCI) has been a significant breakthrough for its treatment. However, clinical application has been hampered by in-stent restenosis (ISR). Although drug eluting stent (DES) has reduced the occurrence of restenosis, incidence of ISR is still about 5% to 10%. The main reasons for restenosis after PCI are hyperplasia of vascular endothelial cells and smooth muscle cell migration. The exact mechanism of personalized differences in restenosis is not clear yet, but there may be a variety of risk factors. In addition to aging, smoking and diabetes, an increasing number of studies have found that genetic and epigenetic factors play an important role in ISR. In this article, authors have reviewed genetic and epigenetic factors on the progression of ISR, which may help to determine the genetic risk factors in patients with ISR after PCI.
Angioplasty, Balloon, Coronary ; methods ; Coronary Restenosis ; etiology ; genetics ; Disease Progression ; Epigenomics ; methods ; Humans ; Stents ; Treatment Outcome

Coronary Restenosis ; etiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Stents ; Thrombosis ; etiology

BACKGROUNDAlthough some certain infectious pathogens could be detected in the patients with coronary artery disease, the roles of these infectious factors in the development of coronary artery diseases remain largely unknown. Since the number of infectious pathogens has been argued to be relative to the coronary artery diseases, we therefore examined whether there is a link between the number of infections and the incidence of in-stent restenosis after stent implantation.

METHODSOne hundred and eighty-one patients were enrolled in this study. Infectious pathogens including serum anti-Chlymydia pneumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-1, human herpes simplex virus-2 antibodies and hepatitis B virus antigen were measured in all patients before coronary stent implantation. Coronary angiography was performed before, immediately after and 6 months after stent implantation.

RESULTSRestenosis rate 6 months post stent implantation was similar in patients with low pathogen burden (< 3 pathogens, 33.3%) to those with high pathogen burden (> or = 3 pathogens, 29.1%).

CONCLUSIONSPrevious infections with Chlymydia pneumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-1, human herpes simplex virus-2 and hepatitis B virus do not contribute to the incidence of restenosis after stent implantation.

Adult ; Aged ; Coronary Disease ; therapy ; Coronary Restenosis ; etiology ; Female ; Humans ; Infection ; complications ; Male ; Middle Aged ; Stents ; adverse effects

BACKGROUNDThe long term prognosis of unprotected left main coronary artery (LMCA) stenting is controversial. This study was conducted to evaluate the immediate and long term outcomes of LMCA stenting in Chinese patients and to determine which factors affect the outcomes.

METHODSFrom May 1997 to March 2003, 224 patients in 23 hospitals underwent elective unprotected LMCA stenting with bare metal stents. Their clinical records were analysed to ascertain immediate and long term outcomes of LMCA stenting as well as factors influencing the prognosis.

RESULTSStents were implanted into LMCA successfully in 223 cases (99.6 %). One death (0.5%) and one case of non-Q wave nonfatal myocardial infarction (MI) occurred in hospital. The mean follow-up time was (15.6 +/- 12.3) months. Cardiac death developed in 10 cases (4.5%), noncardiac death in 2 cases (0.9%), nonfatal MI in 4 cases (1.8%), target lesion revascularization (TLR) of LMCA in 26 cases (11.7%) and TLR of nonLMCA in 37 cases (16.5%). Univariate analysis showed that cardiac death correlated with left ventricular ejection fraction (LVEF < 40%), female gender and LMCA combined with multivessel disease; that major adverse cardiac events (MACE) correlated with LVEF < 40%, bifurcation lesion and incomplete revascularization. Logistic regression analysis revealed that LVEF < 40% and female gender were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases (45.7%). The restenosis rate was 31.4%.

CONCLUSIONSLong-term outcomes of stenting for selected patients with unprotected LMCA stenosis is acceptable. It should be performed in inoperable or low risk patients with LVEF > or = 40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization can be obtained.

Adult ; Aged ; Aged, 80 and over ; Coronary Angiography ; Coronary Disease ; therapy ; Coronary Restenosis ; etiology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stents ; adverse effects ; Treatment Outcome

OBJECTIVETo observe the developing changes of adventitia in restenosis after precutaneous transluminal angioplasty(PTA), and investigate the effect of androgen on restenosis through contrasting the castrated male rat models and its mechanism.

METHODSModels were constructed of castrated male rats and restenosis of the common carotid artery, and specimens were collected at the 3rd, 7th, 14th and 28th day respectively after modeling. Hematoxylin and eosin staining, immunohistochemical staining, and electronic microscopy were performed to observe the condition of restenosis.

RESULTSProliferating cells occurred in adventitia first and phenotype of adventitial cells was changed at the 3rd day after PTA. The adventitial proliferating index was the highest at the 7th day after PTA, and proliferating migration towards intimal was observed. The proliferating cells mostly occurred in the middle layer and neointima at the 14th day after PTA. The areas of adventitia and neointima were larger and the degrees of restenosis were higher in the castrated rats than in the non-castrated ones at different time points. Take the 14 d group, the adventitial area was[(3,566 +/- 337) micron2 vs (2,751 +/- 401) micron2, P = 0.008], the neointimal area[(3,553 +/- 477) micron2 vs (2,757 +/- 435) micron2, P = 0.025], the restenosis rate[(76 +/- 2)% vs (60 +/- 8)%, P = 0.005], and the proliferating index [(29 +/- 2)% vs (13 +/- 1)%, P < 0.001].

CONCLUSIONAdventitial proliferation and migration contribute to restenosis after PTA; Androgen in rats can physiologically relieve restenosis, probably through intervening in the activation of adventitia.

Actins ; analysis ; Androgens ; physiology ; Angioplasty, Balloon, Coronary ; Animals ; Bromodeoxyuridine ; metabolism ; Coronary Restenosis ; etiology ; pathology ; Coronary Vessels ; pathology ; ultrastructure ; Immunohistochemistry ; Male ; Orchiectomy ; Rats ; Rats, Sprague-Dawley

OBJECTIVE: To observe the expression differences of the plasma miRNA-1, miRNA-21 between patients with coronary heart disease (CHD) and without coronary artery lesions, between patients with in-stent restenosis (ISR) and none in-stent restenosis (NISR), and to study their predictive value for ISR occurred after percutaneous coronary intervention (PCI) in patients with CHD and diabetes mellitus (DM). METHODS: The selected subjects were divided into CHD group in which patients were implemented stenting (=187), and control group in which patients were without coronary artery lesions (=195). According to the guidelines, the control group was divided into normal group (=150), simple-DM group (=45); the CHD group was divided into simple-CHD group (=119) and CHD-DM group (=68), the CHD group was also divided into ISR group (=48), NISR group (=139), and the ISR group was divided into simple-ISR group (=26) and ISR-DM group (=22) again. Plasma was collected from each group, and total RNA was extracted, the level of blood miRNA-1, miRNA-21 of each group was detected, and their level differences were analyzed. RESULTS: Compared with control group, the level of miRNA-1 and miRNA-21 of CHD group was increased (<0.05); compared with NISR group, the level of miRNA-1 and miRNA-21 of ISR group was increased (<0.05). The incidence of ISR of CHD-DM group was obviously higher than that of simple-CHD group, ISR-DM group's level of miRNA-21 was higher than that of simple-ISR group (<0.05), and there was no difference of miRNA-1 level between ISR and ISR-DM group (<0.05). In Logistics, for CHD patents, the OR of DM, miRNA-1, miRNA-21 were 2.132, 3.066, 1.924 respectively (<0.05); for CHD patents with ISR, the OR of DM, miRNA-21 were 2.123, 3.066 respectively (<0.05); especially for CHD and DM patents with ISR, the OR of miRNA-21 was 9.148 (<0.05). In ROC curve, for CHD patients with ISR, the AUC of miRNA-1, miRNA-21 were 0.854, 0.857 respectively; for CHD-DM patients with ISR, the AUC of miRNA-21 was 0.783. CONCLUSIONS To predict the occurrence of ISR for CHD patients, the plasma miRNA-1 and miRNA-21 have a relatively high specificity and sensitivity, for CHD patients with DM, miRNA-21 may have a higher clinical value.
Coronary Angiography ; Coronary Restenosis ; etiology ; surgery ; Diabetes Complications ; Diabetes Mellitus ; Humans ; MicroRNAs ; blood ; Nerve Tissue Proteins ; blood ; Percutaneous Coronary Intervention ; Stents

The occurrence rate of restenosis after percutaneous transluminal coronary intervention (PCI) was quite high. Traditional Chinese medicine (TCM) has been proved to have the effect in preventing and curing restenosis. In this article, turbid-phlegm was proved to be directly related with restenosis after PCI in aspects of coronary arteriography, blood lipid, blood viscosity, fibrolysis system, free radicals, plasma homocysteine, insulin resistance, etc. So it is one of the important pathogenetic factors of restenosis after PCI in TCM.
Angioplasty, Balloon, Coronary ; Coronary Restenosis ; drug therapy ; etiology ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Myocardial Infarction ; drug therapy ; therapy ; Phytotherapy

Aged ; Coronary Angiography ; Coronary Restenosis ; diagnostic imaging ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Sirolimus ; administration & dosage ; Stents

OBJECTIVETo determine predictors for in-stent restenosis (ISR) within 2 years after drug-eluting stent (DES) implantation in coronary heart disease patients complicating with diabetes mellitus and to establish predictive model.

METHODSWe retrospectively analyzed clinical data of patients underwent DES implantation in our hospital between January 2005 and December 2012. Using random number generated by SPSS 17.0, a total of 3 073 cases were randomly divided into two cohort, model derivation cohort (MDC) and model validation cohort (MVC). MDC (2 048 cases) was divided into in-stent restenosis (ISR) group and control group. Predictors were identified using univariable and multivariable logistic regression analysis in MDC. Integer point values were assigned to each predictor based upon their β coefficient in multivariable logistic regression model to establish scoring model. The summed scores of each case in MVC (1 025 cases) were calculated to test predictive ability of the model.

RESULTSOf all these 3 073 cases, 217 cases (7.1%) were diagnosed with ISR within 2 year after DES implantation. The incidence of ISR within 2 year after DES implantation was 7.3% (149 cases) in MDC and logistic regression analysis identified six ISR risk factors: multiple target vessels (OR = 3.69, 95%CI: 2.65-8.93, P = 0.000), diffused lesions (OR = 2.92, 95%CI: 2.03-6.46, P = 0.000), GFR < 60 ml×min(-1)·1.73 m(-2) (OR = 4.73, 95%CI: 3.51-10.62, P = 0.000), smoking (OR = 3.37, 95%CI: 2.39-8.46, P = 0.000), age < 60 years old (OR = 1.44, 95%CI:1.26-4.63, P = 0.024), HbAlc ≥ 6.3% (OR = 2.48, 95%CI: 1.84-4.27, P = 0.002). Risk score was well associated with the rate of ISR in MVC. Sensitivity was 76.5% (95%CI: 64.6%-85.9%), specificity was 76.1% (95%CI: 73.2%-78.7%), and areas under the ROC curve was 0.851(95%CI:0.813-0.890, P = 0.000) when score was set at 5.5.

CONCLUSIONSThe incidence of ISR in coronary heart disease patients complicating with diabetes mellitus within 2 years after DES implantation is relatively low. Several factors are associated with ISR in these patients and risk for ISR could be reliably identified by the established scoring model.

Aged ; Coronary Disease ; complications ; epidemiology ; therapy ; Coronary Restenosis ; etiology ; Diabetes Mellitus ; epidemiology ; Drug-Eluting Stents ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies

OBJECTIVETo observe the safety and efficacy of early or non-early controlled-release arsenic-trioxide (As(2)O(3))-eluting stents on reducing in-stent neointimal hyperplasia.

METHODSBare stents, stents coated with polybutyl methacrylate/Nano silica (containing 200 microg of As(2)O(3) per stent or not), stents coated with polybutyl methacrylate/Nano silica inside (containing 200 microg of As(2)O(3) per stent or not) and poly-lactide-co-glycolide (PLGA) outside were deployed with mild oversizing in left anterior descending (LAD) and circumflex coronary arteries (LCX)of 30 canines (n = 6, 12 stents for each group).

RESULTSThe mean injury scores were similar in all groups at 4 weeks post stents implantation while the mean neointimal thickness, neointimal area and degree of stenosis were significantly reduced and the lumen area significantly increased in canines receiving single coating stents containing As(2)O(3) compared with single or double coating stents and bare stents groups (all P < 0.01). These effects were further enhanced in canines implanted with double coating stents containing As(2)O(3) (all P < 0.01 vs. single coating stents containing As(2)O(3)). No intraintimal hemorrhage, medial and adventitial necrosis, aneurysm, thrombosis, inflammatory cells infiltration were observed in all stenting groups.

CONCLUSIONSControlled-release As(2)O(3)-eluting stents resulted in a significant inhibition of neointimal hyperplasia in the canine coronary arteries 4 weeks after stents implantation and the effects is more significant with controlled-release of As(2)O(3) at non-early stage than that at early stage.

Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Animals ; Arsenicals ; administration & dosage ; pharmacology ; Coronary Restenosis ; etiology ; prevention & control ; Disease Models, Animal ; Dogs ; Drug-Eluting Stents ; Oxides ; administration & dosage ; pharmacology