We aimed to investigate that complete revascularization (CR) would be associated with a decreased mortality in patients with multivessel disease (MVD) and reduced left ventricular ejection fraction (LVEF). We enrolled a total of 263 patients with MVD and LVEF <50% who had undergone percutaneous coronary intervention with drug-eluting stent between March 2003 and December 2010. We compared major adverse cardiac and cerebrovascular accident (MACCE) including all-cause death, myocardial infarction, any revascularization, and cerebrovascular accident between CR and incomplete revascularization (IR). CR was achieved in 150 patients. During median follow-up of 40 months, MACCE occurred in 52 (34.7%) patients in the CR group versus 51 (45.1%) patients in the IR group (P=0.06). After a Cox regression model with inverse-probability-of-treatment-weighting using propensity score, the incidence of MACCE of the CR group were lower than those of the IR group (34.7% vs. 45.1%; adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.44-0.95, P=0.03). The rate of all-cause death was significantly lower in patients with CR than in those with IR (adjusted HR, 0.48; 95% CI, 0.29-0.80, P<0.01). In conclusion, the achievement of CR with drug-eluting stent reduces long-term MACCE in patients with MVD and reduced LVEF.
Age Factors ; Aged ; Coronary Artery Disease/*drug therapy/mortality/physiopathology ; Diabetes Mellitus, Type 2/complications ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Percutaneous Coronary Intervention/adverse effects ; Proportional Hazards Models ; Renal Insufficiency, Chronic/complications ; Retrospective Studies ; Sex Factors ; Treatment Outcome ; Ventricular Dysfunction, Left/physiopathology

OBJECTIVEParenterally administered Kudiezi (KDZ) is used in real world clinical situations to treat coronary heart disease and cerebral infarction. This paper analyzes its clinical use with other drug combinations. Clinicians' experiences of using such treatments are also referred to.

METHODHospital information system (HIS) data from 18 hospitals, comprising records of 6 032 patients with Coronary heart disease and 3 468 patients with cerebral infarction were analyzed.

RESULTComparison and analysis between varying courses of KDZ plus different drug combinations was carried out. The mean single dose of KDZ, death rate and improvement rates along with drug combinations were ascertained with various illustrations given.

CONCLUSIONAlthough data showed some clinical correlations between factors analyzed, strong causal relationships are yet to be found. Hence, there is a need for further exploration and analysis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; drug therapy ; mortality ; Coronary Artery Disease ; drug therapy ; mortality ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Hospital Information Systems ; statistics & numerical data ; Humans ; Infusions, Parenteral ; Male ; Middle Aged ; Pragmatic Clinical Trials as Topic ; Retrospective Studies ; Young Adult

BACKGROUND/AIMS: The Taxus Liberte stent (Boston Scientific Co.) evolved from the Taxus Express stent, with enhanced stent deliverability and uniform drug delivery. This study was designed to compare angiographic and clinical outcomes in real-world practice between the Taxus Liberte and Taxus Express stents. METHODS: Between 2006 and 2008, 240 patients receiving the Taxus Liberte stent at three centers were registered and compared to historical control patients who had received the Taxus Express stent (n = 272). After propensity score matching, 173 patients treated with the Taxus Liberte stent and the same number of patients treated with the Taxus Express stent were selected. The primary outcome was a composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), ischemia driven target vessel revascularization (TVR), and stent thrombosis (ST) at 1 year. An additional angiographic assessment was conducted at 9 to 12 months. RESULTS: The study showed no significant difference between the Taxus Express and Taxus Liberte stents (death, 1.73% vs. 2.31%, p = 1.000; MI, 0% vs. 1.73%, p = 0.2478; TVR, 2.31% vs. 1.16%, p = 0.6848; and ST, 0% vs. 1.16%, p = 0.4986). The total MACE rate at 1 year did not differ between the groups (4.05% in Taxus Express vs. 4.05% in Taxus Liberte, p = 1.000). In addition, the binary restenosis rate did not differ (2.25% in Taxus Express vs. 1.80% in Taxus Liberte, p = 0.6848). CONCLUSIONS: In real-world experience with the two Taxus stent designs, both stents showed similarly good clinical and angiographic outcomes at 1 year. A long-term follow-up study is warranted.
Aged ; Angioplasty, Balloon, Coronary/adverse effects/*instrumentation/mortality ; Cardiovascular Agents/administration & dosage ; Chi-Square Distribution ; Coronary Angiography ; Coronary Artery Disease/mortality/radiography/*therapy ; Coronary Restenosis/etiology/mortality ; Coronary Thrombosis/etiology/mortality ; *Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology/mortality ; Paclitaxel/*administration & dosage ; Propensity Score ; Prosthesis Design ; Registries ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Stainless Steel ; Time Factors ; Treatment Outcome

We aimed comparing two-year clinical outcomes of the Everolimus-Eluting Promus and Paclitaxel-Eluting TAXUS Liberte stents used in routine clinical practice. Patients with objective evidence of ischemia and coronary artery disease eligible for PCI were prospectively randomized to everolimus-eluting stent (EES) or paclitaxel-eluting stent (PES) groups. The primary end-point was ischemia-driven target vessel revascularization (TVR) at 2 yr after intervention, and the secondary end-point was a major adverse cardiac event (MACE), such as death, myocardial infarction (MI), target lesion revascularization (TLR), TVR or stent thrombosis. A total of 850 patients with 1,039 lesions was randomized to the EES (n=425) and PES (n=425) groups. Ischemic-driven TVR at 2 yr was 3.8% in the PES and 1.2% in the EES group (P for non-inferiority=0.021). MACE rates were significantly different; 5.6% in PES and 2.5% in EES (P = 0.027). Rates of MI (0.8% in PES vs 0.2% in EES, P = 0.308), all deaths (1.5% in PES vs 1.2% in EES, P = 0.739) and stent thrombosis (0.3% in PES vs 0.7% in EES, P = 0.325) were similar. The clinical outcomes of EES are superior to PES, mainly due to a reduction in the rate of ischemia-driven TVR.
Antineoplastic Agents, Phytogenic/administration & dosage/therapeutic use ; Coronary Artery Disease/*drug therapy/mortality ; Coronary Restenosis/prevention & control ; *Drug-Eluting Stents ; Female ; Humans ; Immunosuppressive Agents/administration & dosage/therapeutic use ; Male ; Middle Aged ; Paclitaxel/administration & dosage/*therapeutic use ; Percutaneous Coronary Intervention/*methods ; Prospective Studies ; Sirolimus/administration & dosage/*analogs & derivatives/therapeutic use ; Thrombosis ; Treatment Outcome

BACKGROUNDCurrently available evidence suggests that outcomes are less favorable when left main (LM) bifurcation lesions are treated with 2-stent techniques compared with a single-stent technique. We aimed to evaluate the long-term outcomes of the 2-stent techniques for treating unprotected LM bifurcation lesions in Chinese patients.

METHODSWe enrolled 301 consecutive patients treated with drug-eluting stents (DES) implantation using 2-stent techniques for unprotected LM bifurcation lesions (MEDINA 1, 1, 1, 70.5%). The 2-stent techniques included crush technique, V stenting, T stenting, and Culottes stenting. After stenting, both vessels were redilated at a high pressure before final kissing balloon (FKB). Clinical and angiographic data were analyzed. The primary endpoints were major adverse cardiac events (MACE), which included death, myocardial infarction, and target lesion revascularization.

RESULTSImmediate procedural success was obtained in all cases with a FKB success rate of 95.3%. Follow-up data were available for all patients. The overall incidence of angiographic in-stent restenosis (ISR) rate was 20.3% and most ISRs were of the focal type. During long-term follow-up (mean duration, (54 ± 22) months), the cumulative incidence of MACE was 11.0%, with 8 (2.7%) deaths, 7 (2.3%) myocardial infarctions, and 18 (6.0%) repeated lesion revascularization. MACEs in high SYNTAX score terciles were significantly higher compared with those in low and intermediate SYNTAX score terciles (P = 0.001).

CONCLUSIONSAlthough percutaneous coronary intervention (PCI) with 2-stent technique for unprotected LM bifurcation lesions was accompanied with a slightly high incidence of ISR, the long-term clinical follow-up is acceptable. Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with LM bifurcation disease treated by PCI.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Disease ; mortality ; therapy ; Coronary Restenosis ; epidemiology ; Drug-Eluting Stents ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; adverse effects ; methods ; Time Factors ; Treatment Outcome

PURPOSE: Coronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs). MATERIALS AND METHODS: The study population was comprised of 199 consecutive patients admitted with unprotected LMCAD. All of the patients were assigned to PCI (88 patients) or CABG (111 patients). The primary clinical end point indicated death, stroke of acute coronary syndrome (ACS). RESULTS: Patients assigned to PCI were at higher operative risk than patients scheduled for CABG (6.49+/-4.09 vs. 4.81+/-2.67, p=0.0032). Comparison of the group that received DESs with the CABG group did not reveal any differences in major adverse cardio-cerebral events (MACCE) occurrence (21% vs. 16%, p=NS). Patients in the CABG and PCI groups died with similar frequency (11% vs. 16%, p=NS). The mortality rate in the CABG group was higher than among those treated with DES (11% vs. 3%, p=0.049). The rate of ACS was higher in the PCI group than in the CABG group (13% vs. 4%, p=0.016). CONCLUSION: Despite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI.
Aged ; Angioplasty, Balloon, Coronary/*mortality ; Cohort Studies ; Coronary Artery Bypass/*mortality ; *Coronary Artery Disease/mortality/surgery/therapy ; Coronary Vessels ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Metals ; Middle Aged ; Risk Factors ; Treatment Outcome

There is no consensus as to which acute myocardial infarction subtype poses a greater risk after coronary artery bypass grafting (CABG). We compared the early and the long term results of off-pump coronary artery bypass grafting (OPCAB) between patients with STEMI (group I, n = 83), and NSTEMI (group II, n = 237). Group I had higher EuroSCORE, prevalence of emergency surgery, preoperative intra-aortic balloon pump use, preoperative emergency percutaneous transluminal coronary angioplasty, and preoperative thrombolytic use than group II. There were no significant differences in 30-day mortality and major adverse cardiac and cerebrovascular event (MACCE) between groups. Overall 8-yr survival was 93% and 87% in groups I and II, respectively. Freedom from MACCE after 8 yr was 92% and 93% in groups I and II, respectively. After propensity score matching analysis, there were no significant differences in preoperative parameters, postoperative in-hospital outcomes, and long-term clinical outcomes. Surgical results of OPCAB in patients with acute myocardial infarction show good results in terms of long-term survival and freedom from MACCE, with no significant differences in clinical outcomes between STEMI and NSTEMI groups.
Acute Disease ; Aged ; Angioplasty, Balloon, Coronary ; *Coronary Artery Bypass, Off-Pump ; Disease-Free Survival ; Electrocardiography ; Female ; Fibrinolytic Agents/therapeutic use ; Humans ; Male ; Middle Aged ; Myocardial Infarction/drug therapy/mortality/*surgery ; Odds Ratio ; Preoperative Period ; Propensity Score

Intravascular ultrasound (IVUS) is a useful diagnostic method that provides valuable information in addition to angiography regarding the coronary vessel lumen, dimensions, plaque burden, and characteristics. The major use of IVUS in coronary intervention is to guide interventional strategies and assess optimal stent deployment. Since the introduction of the drug-eluting stent (DES), concerns about restenosis have decreased. However, high-risk lesion subsets are being routinely treated with DESs, and the incidence of suboptimal results after stent deployment, such as stent underexpansion, incomplete stent apposition, edge dissection, geographic miss, and the risk of stent thrombosis, have correspondingly increased. Thus, optimization of stent deployment under IVUS guidance may be clinically important. In this review, we focus on the potential role of IVUS in stent optimization during percutaneous coronary intervention and its clinical benefits.
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation/mortality ; Coronary Artery Disease/mortality/*therapy/*ultrasonography ; Coronary Restenosis/etiology ; Drug-Eluting Stents ; Evidence-Based Medicine ; Humans ; Myocardial Infarction/etiology ; Prosthesis Design ; *Stents ; Thrombosis/etiology ; Treatment Outcome ; *Ultrasonography, Interventional

INTRODUCTIONEverolimus eluting stents (EES) have demonstrated excellent re-stenosis and thrombosis rates in a number of randomised controlled trials. This study reported the real world experience in a single tertiary centre with EES in predominantly acute coronary syndrome (ACS) patients and compared the outcomes in small and large vessels. We measured the medium to long-term major adverse cardiovascular events (MACE) defined as all-cause mortality, myocardial infarction (MI) and target vessel revascularisation (TVR) and stent thrombosis.

MATERIALS AND METHODSAll consecutive patients underwent percutaneous coronary intervention (PCI) with EES (PROMUSTM, Boston Scientific, Natick USA; XIENCE VTM, Abbott Vascular, Santa Clara USA) between March 2007 and September 2009 recorded in our coronary intervention registry were included in this study. All patients were advised to stay on dual antiplatelet therapy with Aspirin 100 mg/day and Clopidogrel 75 mg/day. All patients had at least 6 months of clopidogrel, government funded and a further 6 months required self funding.

RESULTSFour hundred and six consecutive patients received EES during the study period; 403 were included in this study and 3 were lost to follow-up. Indications for PCI were stable angina in 11% of the patients, unstable angina in 38%, non-ST elevation myocardial infarction in 43%, and ST-elevation myocardial infarction in 8%. Procedural success was achieved in 99.5% of the cases. During a median follow-up of 23 months, 3% of the patients had an MI, 3% underwent TVR, 5% all-cause mortality and 2 (0.5%) cases of definite or probable stent thrombosis. The Kaplan Meier 2-year survival and MACE free survival were 95% and 89% respectively. A subgroup analysis comparing MACE in patients who were treated with a single small (≤ 2.75 mm; n = 91) or large (≥ 3 mm; n = 118). EES did not show significant difference during the 2-year follow-up (12% vs 9%; P = 0.34).

CONCLUSIONEverolimus eluting stent appears to be safe in a real world setting with satisfactory median-term outcomes which include low rates of TVR and other adverse events. EES appear to be equally effective in both small and large vessels.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; methods ; Aspirin ; therapeutic use ; Coronary Artery Disease ; drug therapy ; mortality ; therapy ; Drug-Eluting Stents ; Everolimus ; Female ; Humans ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; New Zealand ; Platelet Aggregation Inhibitors ; therapeutic use ; Registries ; Retrospective Studies ; Sirolimus ; administration & dosage ; analogs & derivatives ; therapeutic use ; Survival Analysis ; Ticlopidine ; analogs & derivatives ; therapeutic use ; Time Factors ; Treatment Outcome

BACKGROUNDInsulin resistance (IR) is significantly associated with coronary artery disease and cardiovascular events in patients with or without type 2 diabetes mellitus. This study aimed to evaluate the influence of IR on long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES) implantation.

METHODSA total of 467 consecutive patients undergoing SES-based PCI were divided into IR group (n = 104) and non-IR group (n = 363). The patients were followed up for one year. The rate of major adverse cardiac events (MACEs) including death, non-fatal myocardial infarction and recurrent angina pectoris was compared by the log-rank test, and the independent risk factors were identified by the Cox regression analysis.

RESULTSMACEs occurred more frequently, and cumulative survival rate was lower in the IR group than in the non-IR group during the follow-up (all P < 0.05). IR was an independent risk factor for the occurrence of cardiac death and non-fatal myocardial infarction (OR = 2.76, 95%CI = 1.35 - 5.47, P = 0.034). Old age, diabetes, and multi-vessel disease were determinants for recurrent angina pectoris after PCI (P < 0.05). Subgroup analysis revealed that IR (OR = 3.35, 95%CI = 1.07 - 13.59, P = 0.013) and multi-vessel disease (OR = 2.19, 95%CI = 1.01 - 5.14, P = 0.044) were independent risk predictors for recurrent angina pectoris in patients with diabetes after PCI.

CONCLUSIONSIR is associated with reduced MACE-free survival and remains an independent predictor for recurrent angina pectoris after PCI with SES implantation.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Disease ; mortality ; therapy ; Diabetes Mellitus, Type 2 ; complications ; Drug-Eluting Stents ; Female ; Humans ; Insulin Resistance ; Male ; Middle Aged ; Proportional Hazards Models