Objective: To compare clinical outcome of paclitaxel eluting stents(PES) versus sirolimus eluting stents(SES) for the treatment of acute ST elevation myocardial infarction. Design and patients: The first 136 consecuti...Objective: To compare clinical outcome of paclitaxel eluting stents(PES) versus sirolimus eluting stents(SES) for the treatment of acute ST elevation myocardial infarction. Design and patients: The first 136 consecutive patients treated exclusively with PES in the setting of primary percutaneous coronary intervention for acute myocardial infarction in this single centre registry were prospectively clinically assessed at 30 days and one year. They were compared with 186 consecutive patients treated exclusively with SES in the preceding period. Setting: Academic tertiary referral centre. Results: At 30 days, the rate of all cause mortality and reinfarction was similar between groups(6.5%v 6.6%for SES and PES, respectively, p=1.0). A significant difference in target vessel revascularisation(TVR) was seen in favour of SES(1.1%v 5.1%for PES, p=0.04). This was driven by stent thrombosis(n=4), especially in the bifurcation stenting(n=2). At one year, no significant differences were seen between groups, with no late thrombosis and 1.5%in-stent restenosis(needing TVR) in PES versus no reinterventions in SES(p=0.2). One year survival free of major adverse cardiac events(MACE) was 90.2%for SES and 85%for PES(p=0.16). Conclusions: No significant differences were seen in MACE-free survival at one year between SES and PES for the treatment of acute myocardial infarction with very low rates of reintervention for restenosis. Bifurcation stenting in acute myocardial infarction should, if possible, be avoided because of the increased risk of stent thrombosis.展开更多
Background-We investigated the pattern of late luminal loss after sirolimus- eluting or bare stem implantation. Methods and Results -The study population co mprised 238 patients treated with sirolimus-eluting stents a...Background-We investigated the pattern of late luminal loss after sirolimus- eluting or bare stem implantation. Methods and Results -The study population co mprised 238 patients treated with sirolimus-eluting stents and 526 patients tre ated with conventional stents. The distribution of late loss of sirolimus stents was largely skewed to the right and differed from the distribution for bare ste nts. When divided according to the presence of binary restenosis(diameter stenos is >50%), restenotic lesions in the bare stem group(26.0%) had a late loss of 1.40±0.64 mm and in the sirolimus group(7.9%) of 1.16±0.76 mm. Nonrestenotic lesions in the bare stent group had a late loss of 0.58±0.44 mm, whereas the la te loss of nonrestenotic lesions in the sirolimus group remained close to zero( -0.05±0.33 mm). Differences between poststenting and follow-up measurements i n the sirolimus group(late loss) resembled variations observed in repeated angio graphic measurements, as assessed from a random sample of 30 segments measured r epeatedly. After multivariate adjustment, stent type did not influence the degre e of late loss in restenotic lesions. However, nonrestenotic bare stents had a s ignificantly larger estimated luminal loss (0.58 mm; 95%CI, 0.52 to 0.65) than sirolimus-eluting stents, for which the predicted late loss was almost 0(-0.04 mm; 95%CI, -0.10 to 0.02). Conclusions -The pattern of late loss after sirol imus-eluting stent implantation follows a peculiar behavior, different from les ions treated with conventional stents. Whether this is explained by an unusual s tatistical distribution or a biological all-or-none response of restenosis aft er sirolimus-eluting stenting remains to be investigated.展开更多
文摘Objective: To compare clinical outcome of paclitaxel eluting stents(PES) versus sirolimus eluting stents(SES) for the treatment of acute ST elevation myocardial infarction. Design and patients: The first 136 consecutive patients treated exclusively with PES in the setting of primary percutaneous coronary intervention for acute myocardial infarction in this single centre registry were prospectively clinically assessed at 30 days and one year. They were compared with 186 consecutive patients treated exclusively with SES in the preceding period. Setting: Academic tertiary referral centre. Results: At 30 days, the rate of all cause mortality and reinfarction was similar between groups(6.5%v 6.6%for SES and PES, respectively, p=1.0). A significant difference in target vessel revascularisation(TVR) was seen in favour of SES(1.1%v 5.1%for PES, p=0.04). This was driven by stent thrombosis(n=4), especially in the bifurcation stenting(n=2). At one year, no significant differences were seen between groups, with no late thrombosis and 1.5%in-stent restenosis(needing TVR) in PES versus no reinterventions in SES(p=0.2). One year survival free of major adverse cardiac events(MACE) was 90.2%for SES and 85%for PES(p=0.16). Conclusions: No significant differences were seen in MACE-free survival at one year between SES and PES for the treatment of acute myocardial infarction with very low rates of reintervention for restenosis. Bifurcation stenting in acute myocardial infarction should, if possible, be avoided because of the increased risk of stent thrombosis.
文摘Background-We investigated the pattern of late luminal loss after sirolimus- eluting or bare stem implantation. Methods and Results -The study population co mprised 238 patients treated with sirolimus-eluting stents and 526 patients tre ated with conventional stents. The distribution of late loss of sirolimus stents was largely skewed to the right and differed from the distribution for bare ste nts. When divided according to the presence of binary restenosis(diameter stenos is >50%), restenotic lesions in the bare stem group(26.0%) had a late loss of 1.40±0.64 mm and in the sirolimus group(7.9%) of 1.16±0.76 mm. Nonrestenotic lesions in the bare stent group had a late loss of 0.58±0.44 mm, whereas the la te loss of nonrestenotic lesions in the sirolimus group remained close to zero( -0.05±0.33 mm). Differences between poststenting and follow-up measurements i n the sirolimus group(late loss) resembled variations observed in repeated angio graphic measurements, as assessed from a random sample of 30 segments measured r epeatedly. After multivariate adjustment, stent type did not influence the degre e of late loss in restenotic lesions. However, nonrestenotic bare stents had a s ignificantly larger estimated luminal loss (0.58 mm; 95%CI, 0.52 to 0.65) than sirolimus-eluting stents, for which the predicted late loss was almost 0(-0.04 mm; 95%CI, -0.10 to 0.02). Conclusions -The pattern of late loss after sirol imus-eluting stent implantation follows a peculiar behavior, different from les ions treated with conventional stents. Whether this is explained by an unusual s tatistical distribution or a biological all-or-none response of restenosis aft er sirolimus-eluting stenting remains to be investigated.
