Early local intracoronary platelet activation after drug-eluting stent placement

Background Early local platelet activation after coronary intervention identifies patients at increased risk of acute stent thrombosis （AST）. However, early changes in platelet activation in coronary circulation following drug-eluting stent （DES） implantation have never been reported. Methods In a prospective study of 26 consecutive elective stable angina patients, platelet activation was analyzed by measuring soluble glycoprotein V （sGPV） and P-selectin （CD62P） before and after implantation of either DES or bare metal stent （BMS）. All patients were pretreated with clopidogrel （300 mg loading dose） and aspirin （75 mg orally） the day before the procedure. Blood samples were drawn from the coronary ostium and 10 - 20 mm distal to the lesion site. Results Consistent with the lower baseline clinical risk, the levels of CD62P and sGPV were within normal reference range, both in the coronary ostium and distal to the lesion before percutaneous coronary intervention （PCI） procedure. The levels of CD62P and sGPV did not change significantly （CD62P： （31.1 ± 9.86） ng/ml vs （29.5 ± 9.02） ng/ml, P=0.319 and sGPV： （52.4 ± 13.5） ng/ml vs （51.8 ± 11.7） ng/ml, P=0.674, respectively） after stent implantation when compared with baseline. Changes in these platelet activation markers did not differ between stent types. Conclusions Intracoronary local platelet activation does not occur in stable angina patients before and immediately followina DES implantation when dual anti-Dlatelet is administered.

Clinical outcome of patients with left anterior descending artery ostial lesions treated with percutaneous coronary intervention; case-matched comparison with bypass surgery

Objective To assess the immediate and late clinical outcome of left anterior descending artery ostial lesions treated with percutaneous coronary intervention.Methods Seventeen patients (6 females and 11 males) treated with percutaneous coronary intervention for ostial left anterior descending artery stenoses have had clinical follow-ups over 12 months. Clinical events were defined as an occurrence of death, myocardial infarction, recurrent angina, and reguiring repeat revascularization (either by angioplasty or by surgery). A matched population treated with coronary bypass surgery was selected based on the similarities in age, left ventricular ejection fraction and the number of diseased vessels. Kaplan-Meier event-free survival curves were generated and the matched comparison was done using the Chi-square test (Mc Neimar method).Results In the catheter-based angioplasty group, the patients' mean age was 63 ? years. One patient was treated with directional atherectomy plus balloon, 6 with rotational atherectomy plus balloon, 7 with stent and 3 with rotational atherectomy plus stent. Glycoprotein Ⅱ b/ Ⅲ a antagonist was used in 4 cases. Initial procedural success without major complications was achieved in all cases. The mean reference diameter was 2. 90±0. 48 mm. The minimum lumen diameter increased from 1. 05±0. 30 mm to 2.40±0. 45 mm, and the diameter stenosis decreased from 64%±7% to 8%±13%. During the follow-up period, adverse events reguiring repeat revascularization occurred in 8 patients. The event-free probability was 0.42±0.14 in a two-year period. In a matched population treated with bypass surgery (single mammary graft), only one event occurred, and the difference in event-free survival in two-year period between the two patient groups was significant.Conclusions Percutaneous coronary intervention for left coronary descending artery ostial lesion is technically feasible and safe, leading to an optimal early success rate, but has a higher risk of late restenosis and greater need for repeat revascularization than coronary bypass surgery.