OBJECTIVETo explore the relationship between Tpeak-Tend interval (Tpe) and the extent and severity of coronary artery stenosis, and evaluate the effect of percutaneous transluminal coronary angioplasty and stent implantation (PCI) on Tpe in the patients with coronary heart disease (CHD).

METHODSThe ECG data were collected from 187 CHD patients undergoing coronary angiography and PCI to evaluate the extend and severity of coronary artery stenosis before and after the interventions.

RESULTSThe Tpe of patients with severe stenosis increased significantly as compared with that in patients with moderate stenosis (138.9-/+16.2 ms vs 116.5-/+13.7 ms, P<0.05), and a significant difference was also noted between the moderate stenosis and mild stenosis (86.4-/+12.9 ms) groups (P<0.05). The Tpe decreased significantly in the patients in the order of multi-vessel involvement (140.7-/+17.8 ms), double vessel involvement (118.6-/+14.9 ms), singly vessel involvement (100.5-/+13.2 ms), and stenosis-free (84.3-/+12.4 ms) groups (P<0.05). Tpe was correlated to the extent and severity of coronary artery stenosis (r>0.4). In patients with severe stenosis, the Tpe was significantly reduced at 1 h, 24 h, and 1 week after PCI (115.8-/+14.5, 92.7-/+12.9, and 88.2-/+11.3 ms, respectively, P<0.05).

CONCLUSIONThe Tpe can reflect the severity and range of coronary artery stenosis, which can be reduced by PCI. Tpe can be a new index for evaluating myocardial ischemia in CHD patients.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Stenosis ; physiopathology ; therapy ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

Coronary Restenosis ; prevention & control ; therapy ; Coronary Stenosis ; therapy ; Drug Delivery Systems ; Humans ; Medicine, Chinese Traditional ; methods ; Stents

OBJECTIVETo evaluate the clinical outcomes of treating bifurcation lesions with two drug-eluting stent (DES) techniques.

METHODSFrom October 2003 to June 2005, 112 patients with 113 bifurcation lesions with severe stenosis at the ostium of side branch and the diameter > or = 2.50 mm were treated by two DES. Sixty-two of the bifurcation lesions were located in LAD/diagonal (54.9%), 32 in distal left main coronary arteries (28.3%), 18 in LCX/OM (15.9%) and 1 distal RCA (0.9%). Sixty-four lesions were treated with Crush technique, 27 with "T-form" stent implanting technique, 11 with modified "Y-form" stent implanting technique, 5 with kissing technique, 3 with "V-form" stent implanting technique and 3 with Culotta technique. Ninety-one Cypher or Cypher select DES stents, 74 TAXUS DES stents, 67 Firebird stents were used for 226 lesions. Final kissing balloon inflation was performed in 60 bifurcation lesions (93.7%) after 64 Crush stenting procedure.

RESULTSSuccess rate of PCI procedure for the bifurcation lesions was 100%. One patient developed subacute stent thrombosis and underwent successful urgent revascularization. In-hospital major adverse cardiac events (death, AMI, revascularization, MACE) rate was 0.89% (1/112). Nine months follow-up was made in all 112 patients and all patients were alive and MACE rate was 8.04% (9/112) with 1 AMI occurred during the follow-up period in 1 patient due to late thrombosis. Follow-up coronary angiography at 9 months was performed in 48 patients (42.9%) and evidenced 8 in-stent restenosis (16.7%) and 1 patient received CABG, re-PCI was performed in 5 patients.

CONCLUSIONTwo DES technique for the treatment of bifurcation lesions is safe and effective and short- and long-term outcomes is satisfactory.

Adult ; Aged ; Coronary Artery Disease ; therapy ; Coronary Restenosis ; therapy ; Coronary Stenosis ; therapy ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo investigate the impact of depression on clinical outcome of patients undergoing revascularization.

METHODSSelf-rating depression scale (SDS) assessment was made before and after coronary artery bypass grafting (CABG, n = 345) and percutaneous coronary intervention (PCI, n = 308) procedure. Patients were divided into depression and non-depression group. All patients were followed up for 12 months after procedure for the occurrence of rehospitalization and major adverse cardiovascular events (MACE) including all-cause mortality, nonfatal myocardial infarction or target lesion revascularization.

RESULTSDepression was present in 40.9% (n = 141) of patients after CABG, which was significantly higher than before procedure (24.3%, P < 0.01). The MACE rate was significantly higher in patients with post-procedure depression [8.5% (12/141)] than in patients without depression [2.9% (6/204), P < 0.05] and the incidences of target lesion revascularization and rehospitalization were also significantly higher in depression patients than in non-depression patients during the 12 months follow-up (all P < 0.05). Depression was present in 36.4% (n = 112) of patients after PCI, which was significantly higher than that before procedure (28.6%, P < 0.05). The MACE rate [8.0% (9/112) vs. 2.0% (4/196)] and rehospitalization rate [12.5% (14/112) vs. 4.6% (9/196)] were significantly higher in depression patients than in patients without depression during the 12 months follow-up (P < 0.05). There was no significant difference on SDS score between the PCI and CABG before the procedure. However, after the procedure, the SDS score for patients undergoing CABG was significantly higher than in patients undergoing PCI (48.9 ± 9.8 vs. 45.7 ± 10.5 P = 0.01). The level of serum IL-6 was significantly higher in depression patients than in patients without depression (P < 0.05).

CONCLUSIONPrevalence of depression is high in patients treated with revascularization procedures and is linked with poor post-procedure prognosis.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Disease ; diagnosis ; psychology ; therapy ; Coronary Stenosis ; Depression ; etiology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Treatment Outcome

PURPOSE: Several studies have compared the effects of coronary stenting and coronary-artery bypass grafting (CABG) on left main coronary artery (LMCA) disease. However, there are limited data on the long-term outcomes of these two interventions in diabetic patients. MATERIALS AND METHODS: We evaluated 56 patients with LMCA stenosis who underwent drug-eluting stent (DES) implantation and 116 patients who underwent CABG in a single hospital in China between January 2004 and December 2006. We compared long-term major adverse cardiac events (death; a "serious outcome" composite of death, myocardial infarction, or stroke; and target-vessel revascularization). RESULTS: In-hospital (30-day) mortality was 0% for the DES group and 3.4% for the CABG group (p=0.31). There was no difference between the two groups in terms of risk of death [hazard ratio for stenting group, 0.49; 95% confidence interval (CI), 0.13-1.63; p=0.55] or risk of serious outcome (hazard ratio for DES group, 1.11; 95% CI, 0.39-1.45; p=0.47). The target-vessel revascularization rate was higher in the DES group than in the CABG group (hazard ratio, 3.67; 95% CI, 1.24-11.06; p=0.018). CONCLUSION: In this cohort of diabetic patients with LMCA stenosis, there was no difference in composite endpoints between patients receiving DESs and those undergoing CABG. However, stenting was associated with higher rates of target-vessel revascularization than CABG. DES implantation in diabetic patients with LMCA disease was found to be at least as safe as CABG.
Angioplasty, Balloon, Coronary/*methods ; Coronary Stenosis/*therapy ; Diabetes Mellitus ; *Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

The present study in angulated coronary stenosis used human in vivo hemodynamic parameters and computed simulation, both qualitatively and qualitatively, to evaluate the influence of flow velocity and wall shear stress (WSS) on coronary atherosclerosis, the changes of hemodynamic indices following coronary stenting, and their effect on evolving in-stent restenosis. Initial and follow-up coronary angiographies in patients with angulated coronary stenosis were performed (n=60). The optimal degree of coronary stenting for angulated coronary stenosis had two models, the less than 50% angle changed group (model 1, n=33) and the more than 50% angle changed group (model 2, n=27). This angle change was based on the percentage change of vascular angle between pre- and post-intracoronary stenting. The flow-velocity wave obtained from in vivo intracoronary Doppler study data was used for in vitro numerical simulation. Spatial and temporal patterns of the flow-velocity vector and recirculation area were drawn throughout the selected segment of coronary models. WSS of pre- and post-intracoronary stenting was calculated from three-dimensional computer simulation. As results, follow-up coronary angiogram demonstrated significant difference in the percentage of diameter stenosis between the two groups (group 1: 40.3 +/- 30.2 vs. group 2: 25.5 +/- 22.5%, p < 0.05). Negative shear area on 3D simulation, which is consistent with the re-circulation area of flow vector, was noted on the inner wall of the post-stenotic area before stenting. The negative WSS disappeared after stenting. High spatial and temporal WSS before stenting fell within the range of physiologic WSS after stenting. This finding was more prominent in model 2 (p < 0.01). The present study suggests that hemodynamic forces exerted by pulsatile coronary circulation, termed WSS, might affect the evolution of atherosclerosis within the angulated vascular curvature. Moreover, geometric characteristics, such as the angular difference between pre- and post- intracoronary stenting might define optimal rheologic properties for vascular repair after stenting.
Adult ; Aged ; Biomechanics ; *Coronary Circulation ; Coronary Stenosis/*physiopathology/therapy ; Female ; *Hemodynamics ; Human ; Male ; Middle Age ; *Stents ; Stress, Mechanical

BACKGROUNDFailure of balloon catheter passing through the occluded segment accounts for 10% - 15% of all procedures during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). We sought to investigate an original technique for facilitating balloon catheter passing by multi-wire plaque crushing.

METHODSBetween July 2000 and October 2007, 152 patients with 164 CTO lesions who had failed balloon passing were treated by multi-wire plaque crushing technique. The main process of this technique was to insert 1 or 2 wires along with the original wire located in the true lumen of CTO lesions after balloon failure for plaque crushing and then to withdraw the crushing wires to get an enlarged lumen inside of the occlusion segment, thus facilitating the balloon passing.

RESULTSBoth overall lesion and technique success rates were 91.5% (150/164). A total of 211 crushing wires were used during PCI, including 1 crushing wire for 117 (71.3%) lesions and 2 crushing wires for 47 (28.7%) lesions. Approximately 57.3% (121/211) of all crushing wires were those already used in the same procedure. Technique failure occurred in 14 lesions (8.5%). Technique failure was due to crushing wires entering false lumen (92.9%, 13/14) and coronary perforation (7.1%, 1/14). Major procedural complications included coronary perforation (1 case) and severe coronary dissection (2 cases), all of which were successfully treated.

CONCLUSIONSMulti-wire plaque crushing technique is effective in facilitating balloon catheter passing during CTO PCI. It is feasible, economical and relatively safe with a low rate of procedural complications.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; instrumentation ; methods ; Chronic Disease ; Coronary Stenosis ; therapy ; Female ; Humans ; Male ; Middle Aged

Insulin resistance is an important risk factor for coronary artery disease. However, there has been no data regarding its clinical effect on the outcomes of percutaneous coronary intervention (PCI) in non-diabetic patients. We analyzed 98 non-diabetic consecutive patients (59+/-11.5 yr, male:female=63:35) who underwent elective coronary angiography. The patients were divided into two groups: Group I (n=71; the value of HOMA-IR [homeostasis model assessment of insulin resistance] <2.6) and Group II (n=27; the value of HOMA-IR > or = 2.6). In-hospital and 30-day major adverse cardiac events (MACE) were compared between the two groups. The concentrations of fasting insulin and triglyceride were significantly higher in Group II than in Group I. Significant correlations were observed between the value of HOMA-IR and body mass index (r=0.489, p<0.001), levels of total cholesterol (r=0.204, p=0.045), triglyceride (r=0.334, p=0.001) and apolipoprotein B (r=0.212, p=0.038). PCI was performed in 59 patients (60.2%). In-hospital and 30-day MACE were higher in Group II than Group I (2.4% vs. 27.8%, p=0.008; 2.4% vs. 27.8%, p=0.008). Multivariate analysis revealed that the value of HOMA-IR > or = 2.6 was an independent predictor of MACE. Increased HOMA-IR level is an important prognostic indicator in non-diabetic patients underwent PCI.
Prognosis ; Models, Biological ; Middle Aged ; Male ; *Insulin Resistance ; Humans ; Homeostasis ; Female ; Coronary Stenosis/blood/physiopathology/therapy ; Coronary Arteriosclerosis/blood/physiopathology/therapy ; *Angioplasty, Transluminal, Percutaneous Coronary/adverse effects ; Aged

OBJECTIVETo evaluate the clinical outcomes of treating bifurcation lesions with two drug-eluting stent (DES) techniques.

METHODSFrom October 2003 to February 2005, Seventy-one patients with 72 bifurcation lesions (the ostium of side branch > 2.5 mm in diameter) were treated by two DES. Forty-five of the bifurcation lesions were located in LAD/Diagonal (62.5%), 20 in distal left main coronary arteries (27.8%), 6 in LCX/OM (8.3%) and 1 distal RCA (1.4%). The Crush or modified Crush technique was used in 42, "T" technique in 19, modified "Y" technique in 5, "V" technique in 3 and Culotta technique in 3 bifurcation lesions, respectively. Fifty-nine Cypher or Cypher Select stents, 48 TAXUS stents, 25 Firebird stents and 24 bare metal stents were used for 144 lesions. Final kissing balloon inflation was performed in 60 bifurcation lesions (83.3%) after stenting procedure.

RESULTSSuccess rate of PCI procedure for the bifurcation lesions was 100%. One patient developed subacute stent thrombosis and underwent successful urgent revascularization. In-hospital major adverse cardiac events (MACE, death, AMI, revascularization) rate was 1.4% (1/71). Six months follow-up was made in 16 patients. No death and AMI occurred during the follow-up period in these patients. Total occlusion in ostium of the diagonal vessel was found in one patient with LAD/Diagonal bifurcation lesion 6 months post procedure. MACE rate during the follow-up was 6.3% (1/16).

CONCLUSIONThis study showed that the use of two DES techniques for the treatment of bifurcation lesions was safe and effective. The short-term outcome for this strategy was very satisfactory and primary data of 6-month follow-up also showed satisfactory results.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Coronary Restenosis ; therapy ; Coronary Stenosis ; therapy ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome

Aged ; Aged, 80 and over ; Coronary Artery Disease ; complications ; therapy ; Coronary Stenosis ; complications ; therapy ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention