treatment of left main coronary artery （LMCA） disease in select patients. However, it is unclear whether drug-eluting stents （DESs） have better outcomes in patients with LMCA disease compared with bare-metal stent...treatment of left main coronary artery （LMCA） disease in select patients. However, it is unclear whether drug-eluting stents （DESs） have better outcomes in patients with LMCA disease compared with bare-metal stent （BMS） during long-term follow-up in Chinese populations. Methods： From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups： 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events （MACEs）, including cardiovascular （CV） death, myocardial infarction （MI）, and target lesion revascularization （TLR） at 5 years postimplantation. Results： Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE （19.4% vs. 31.8%, P = 0.022）, CV death （7.0% vs. 14.7%, P = 0.045）, and MI （5.4% vs. 12.4%, P = 0.049） than the BMS group. There were no significant differences in the rate of TLR （10.9% vs. 17.8%, P = 0.110） and stent thrombosis （4.7% vs. 3.9%, P = 0.758）. The rates of MACE （80.6% vs. 68.2%, P = 0.023）, CV death （93.0% vs. 85.3%, P - 0.045）, TLR （84.5% vs. 72.1%, P = 0.014）, and MI （89.9% vs. 80.6%, P = 0.029） free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and M1 were 0.41 （95% confidence interval [C/l： 0.21-0.63, P = 0.029） and 0.29 （95% CI： 0.08-0.92, P = 0.037）, respectively. Conelusions： DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.展开更多
Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatmen...Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.展开更多
A meta-analysis was performed to address the efficacy and safety of paclitaxel-eluting stent(PES) in ST-segment elevation myocardial infarction(STEMI) patients.A systematic literature search was conducted to identify ...A meta-analysis was performed to address the efficacy and safety of paclitaxel-eluting stent(PES) in ST-segment elevation myocardial infarction(STEMI) patients.A systematic literature search was conducted to identify all randomized clinical trials in mortality,recurrent myocardial infarction(rMI),repeat revascularization(RR),and stent thrombosis(ST).A total of 4190 STEMI patients were enrolled in six randomized trials comparing PES with bare-metal stent(BMS).The pooled repeat revascularization rate was 5.7% in PES group,significantly lower than 10.0% in BMS group with an odds ratio(OR) of 0.56,95% confidence interval(CI) [0.44,0.72](P<0.00001).No significant difference was found between PES and BMS groups in mortality at one year after the indexing procedure(3.9% vs.5.1%,OR 0.88,95% CI [0.63,1.21],P=0.42).Similarly,rMI rate did not differ significantly between the two groups(3.4% vs.4.1%,OR 0.80,95% CI [0.56,1.13],P=0.21).PES was also associated with the comparable pooled rate of definite stent thrombosis with BMS(2.3% vs.2.4%,OR 0.81,95% CI [0.52,1.26],P=0.35).The results show that PES improved clinical outcomes in STEMI patients with a decreased need for repeat revascularization and no concerns for safety.展开更多
Very late stent thrombosis （VLST） is increasingly being regarded as a complication of drug-eluting stents （DES）, and delayed endothelization, local hypersensitivity reactions, and late stent malapposition due to e...Very late stent thrombosis （VLST） is increasingly being regarded as a complication of drug-eluting stents （DES）, and delayed endothelization, local hypersensitivity reactions, and late stent malapposition due to excessive positive remodeling have been postulated as mechanisms. Considering that stent endothelialization seems to be completed within 4 weeks following bare-metal stent （BMS） placement and that BMS do not possess antiproliferative coating, the mechanism of VLST may differ between patients with DES and those with BMS. We report a case of VLST 9 years after BMS implantation, in which thrombus from the ruptured neointima was confirmed by intravascular ultrasound. This finding suggests that de novo plaque rupture at the neointimal layer within the stent may be one of the explanations for VLST.展开更多
Background In response to the increasing concern with the safety of the drug-eluting stent （DES）, the present study aimed to evaluate the long-term safety and efficacy of DES used for a Chinese patient population. M...Background In response to the increasing concern with the safety of the drug-eluting stent （DES）, the present study aimed to evaluate the long-term safety and efficacy of DES used for a Chinese patient population. Methods All patients, who underwent an index elective percutaneous coronary intervention with an implantation of either DES or bare-metal stent （BMS） in a single institution from April 2004 to December 2006, were included in the analysis. A propensity-score matching technique was applied to adjust and to minimize the impact of confounding factors. Results Overall, there were 1465 patients （20.2%） who had undergone an implantation of only BMS, and 5769 patients （79.8%） of only DES. The propensity-score matching technique set up 1321 pairs of patients for analysis. There were no significant differences between the rates of stent thrombosis （definite and probable） of the two groups （1.06% vs 1.21%, P=0.8580）. Although rates of mortality and myocardial infarction （MI） during the 2-year follow-up period had not differed significantly, rates of death/MI （3.0% vs 4.5%, P=0.0263）, target-lesion revascularization （TLR, 3.2% vs 8.5, P=0.0001）, target-vessel revascularization （TVR, 5.8% vs 9.5%, P 〈0.0001） and any revascularization （10.0% vs 13.3%, P=0.0066） were significantly lower for the DES group than for the BMS group. Among the patients in whom devices were implanted for off-label indications, the propensity-score matched rates of stent thrombosis, mortality, MI, and death/MI were not significantly different, while rates of TLR, TVR and any revascularization were significantly lower for the DES group than for the BMS group. Conclusions During the 2 years of follow-up post stenting, DES use is associated with lower rates of death/MI, TLR, TVR and any revascularization, compared with BMS, in propensity-score matched Chinese patient populations. In the setting of off-label usage, DES use is also associated with similar advantages.展开更多
文摘treatment of left main coronary artery （LMCA） disease in select patients. However, it is unclear whether drug-eluting stents （DESs） have better outcomes in patients with LMCA disease compared with bare-metal stent （BMS） during long-term follow-up in Chinese populations. Methods： From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups： 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events （MACEs）, including cardiovascular （CV） death, myocardial infarction （MI）, and target lesion revascularization （TLR） at 5 years postimplantation. Results： Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE （19.4% vs. 31.8%, P = 0.022）, CV death （7.0% vs. 14.7%, P = 0.045）, and MI （5.4% vs. 12.4%, P = 0.049） than the BMS group. There were no significant differences in the rate of TLR （10.9% vs. 17.8%, P = 0.110） and stent thrombosis （4.7% vs. 3.9%, P = 0.758）. The rates of MACE （80.6% vs. 68.2%, P = 0.023）, CV death （93.0% vs. 85.3%, P - 0.045）, TLR （84.5% vs. 72.1%, P = 0.014）, and MI （89.9% vs. 80.6%, P = 0.029） free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and M1 were 0.41 （95% confidence interval [C/l： 0.21-0.63, P = 0.029） and 0.29 （95% CI： 0.08-0.92, P = 0.037）, respectively. Conelusions： DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.
基金Project (No.08XD14026) supported by the Program of Shanghai Subject Chief Scientist,China
文摘Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.
文摘A meta-analysis was performed to address the efficacy and safety of paclitaxel-eluting stent(PES) in ST-segment elevation myocardial infarction(STEMI) patients.A systematic literature search was conducted to identify all randomized clinical trials in mortality,recurrent myocardial infarction(rMI),repeat revascularization(RR),and stent thrombosis(ST).A total of 4190 STEMI patients were enrolled in six randomized trials comparing PES with bare-metal stent(BMS).The pooled repeat revascularization rate was 5.7% in PES group,significantly lower than 10.0% in BMS group with an odds ratio(OR) of 0.56,95% confidence interval(CI) [0.44,0.72](P<0.00001).No significant difference was found between PES and BMS groups in mortality at one year after the indexing procedure(3.9% vs.5.1%,OR 0.88,95% CI [0.63,1.21],P=0.42).Similarly,rMI rate did not differ significantly between the two groups(3.4% vs.4.1%,OR 0.80,95% CI [0.56,1.13],P=0.21).PES was also associated with the comparable pooled rate of definite stent thrombosis with BMS(2.3% vs.2.4%,OR 0.81,95% CI [0.52,1.26],P=0.35).The results show that PES improved clinical outcomes in STEMI patients with a decreased need for repeat revascularization and no concerns for safety.
文摘Very late stent thrombosis （VLST） is increasingly being regarded as a complication of drug-eluting stents （DES）, and delayed endothelization, local hypersensitivity reactions, and late stent malapposition due to excessive positive remodeling have been postulated as mechanisms. Considering that stent endothelialization seems to be completed within 4 weeks following bare-metal stent （BMS） placement and that BMS do not possess antiproliferative coating, the mechanism of VLST may differ between patients with DES and those with BMS. We report a case of VLST 9 years after BMS implantation, in which thrombus from the ruptured neointima was confirmed by intravascular ultrasound. This finding suggests that de novo plaque rupture at the neointimal layer within the stent may be one of the explanations for VLST.
文摘Background In response to the increasing concern with the safety of the drug-eluting stent （DES）, the present study aimed to evaluate the long-term safety and efficacy of DES used for a Chinese patient population. Methods All patients, who underwent an index elective percutaneous coronary intervention with an implantation of either DES or bare-metal stent （BMS） in a single institution from April 2004 to December 2006, were included in the analysis. A propensity-score matching technique was applied to adjust and to minimize the impact of confounding factors. Results Overall, there were 1465 patients （20.2%） who had undergone an implantation of only BMS, and 5769 patients （79.8%） of only DES. The propensity-score matching technique set up 1321 pairs of patients for analysis. There were no significant differences between the rates of stent thrombosis （definite and probable） of the two groups （1.06% vs 1.21%, P=0.8580）. Although rates of mortality and myocardial infarction （MI） during the 2-year follow-up period had not differed significantly, rates of death/MI （3.0% vs 4.5%, P=0.0263）, target-lesion revascularization （TLR, 3.2% vs 8.5, P=0.0001）, target-vessel revascularization （TVR, 5.8% vs 9.5%, P 〈0.0001） and any revascularization （10.0% vs 13.3%, P=0.0066） were significantly lower for the DES group than for the BMS group. Among the patients in whom devices were implanted for off-label indications, the propensity-score matched rates of stent thrombosis, mortality, MI, and death/MI were not significantly different, while rates of TLR, TVR and any revascularization were significantly lower for the DES group than for the BMS group. Conclusions During the 2 years of follow-up post stenting, DES use is associated with lower rates of death/MI, TLR, TVR and any revascularization, compared with BMS, in propensity-score matched Chinese patient populations. In the setting of off-label usage, DES use is also associated with similar advantages.
