Domestic versus imported drug-eluting stents for the treatment of patients with acute coronary syndrome

BACKGROUND:The application of coronary stents,especially drug-eluting stents(DESs),has made percutaneous coronary intervention(PCI) one of important therapeutic methods for CHD. DES has reduced the in-stent restenosis to 5%–9% and signifi cantly improved the long-term prognosis of patients with CHD. The study aimed to investigate the long-term eff icacy and safety of domestic drugeluting stents(DESs) in patients with acute coronary syndrome(ACS).METHODS:All patients with ACS who had undergone successful percutaneous coronary intervention(PCI) in the First Aff iliated Hospital of Zhengzhou University from July 2009 to December 2010 were included in this study. Patients were excluded from the study if they were implanted with bare metal stents or different stents(domestic and imported DESs) simultaneously. The included patients were divided into two groups according to different stents implanted:domestic DESs and imported DESs.RESULTS:In the 1 683 patients of this study,1 558(92.6%) patients were followed up successfully for an average of(29.1±5.9) months. 130(8.3%) patients had major adverse cardiovascular events(MACEs),including cardiac death in 32(2.1%) patients,recurrent myocardial infarction in 16(1%),and revascularization in 94(6%). The rates of cardiac death,recurrent myocardial infarction,revascularization,in-stent restenosis,stent thrombosis and other MACEs were not signif icantly different between the two groups(all P>0.05). Multivarite logistic regression revealed that diabetes mellitus(OR=1.75,95%CI:1.09–2.82,P=0.021),vascular numbers of PCI(OR=2.16,95%CI:1.22–3.83,P=0.09) and PCI with left main lesion(OR=9.47,95%CI:2.96–30.26,P=0.01) were independent prognostic factors of MACEs. The Kaplan-Meier method revealed that there was no significant difference in cumulative survival rates and survival rates free from clinical events between the two groups(all P>0.05).CONCLUSIONS:The incidences of clinical events and cumulative survival rates are not statistically different between domestic DESs and imported DESs. Domestic DES is effective and safe in the treatment of patients with ACS.

Interleukin-18, matrix metalloproteinase-22 and -29 are independent risk factors of human coronary heart disease

Background： Coronary heart disease （CHD） is characterized by arterial wall inflammation and matrixdegradation. Matrix metalloproteinase （MMP）-22 and -29 and pro-inflammatory cytokine interleukin-18 （IL18） arepresent in human hearts. IL18 may regulate MMP-22 and -29 expression, which may correlate with CHD progression.Methods and results： Immunoblot analysis showed that ILl8 induced MMP-22 expression in human aortic smoothmuscle cells. The Mann Whitney test from a prospective study of 194 CHD patients and 68 non-CHD controlsdemonstrated higher plasma levels of IL18, MMP-22 and-29 in CHD patients than in the controls. A logistic regressiontest suggested that plasma IL18 （odds ratio （OR）=1.131, P=0.007）, MMP-22 （OR=1.213, P=0.040）, and MMP-29（OR=1.198, P=0.033） were independent risk factors of CHD. Pearson＇s correlation test showed that IL18 （coefficient（r）=0.214, P=0.045; r=0.246, P=0.031） and MMP-22 （t=0.273, P=0.006; r=0.286, P=0.012） were associated with theGensini score before and after adjusting for potential confounding factors. The multivariate Pearson＇s correlation testshowed that plasma MMP-22 levels correlated positively with high-sensitive-C-reactive protein （hs-CRP） （r=0.167,P=0.023）, and MMP-29 levels correlated negatively with triglyceride （t=-0.169, ,P=-0.018）. Spearman＇s correlation testindicated that plasma IL18 levels associated positively with plasma MMP-22 （t=0.845, P〈0.001） and MMP-29 （r=0.548P〈0.001）. Conclusions： Our observations suggest that IL18, MMP-22 and -29 serve as biomarkers and independentrisk factors of CHD. Increased systemic IL18 in CHD patients may contribute to elevated plasma MMP-22 and -29levels in these patients.