Background Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent im...Background Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography （OCT） to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent （DES） implantation. Methods Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study. Results Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study： （1） superficial intimal tears （n=3）, （2） subintimal dissections （n=4）, （3） split of media （n=1）, （4） disruption of the fibrotic cap of plaque （n=1）. Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections （1.682±0.425 vs. 1.229±0.285, P=0.0290; 1.507±0.445 vs. 1.174±0.265, P=0.0072）. Conclusions The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.展开更多
Background Omeprazole, usually used in the antiplatelet therapy during percutaneous coronary intervention （PCI） in acute coronary syndrome （ACS）, has been reported to increase ischemic events in retrospective stud...Background Omeprazole, usually used in the antiplatelet therapy during percutaneous coronary intervention （PCI） in acute coronary syndrome （ACS）, has been reported to increase ischemic events in retrospective studies. However, other clinical trials gave paradoxical results. The aim of this study was to assess the effects of omeprazole on clopidogrel efficacy and clinical events.Methods All patients （n=172） received aspirin （loading dose 300 mg and maintenance dose 100 mg/d） and clopidogrel （loading dose 600 mg and maintenance dose 75 mg/d） during the therapy. They were randomized to receive omeprazole （20 mg/d） or placebo for 30 days. Residual platelet activities in the adenosine 5＇-diphosphate （ADP） pathway were detected on the fifth day after PCI with thrombelastography （TEG）-mapping. The clinical events were recorded after one month.Results According to the five levels of platelet activities, the frequency distributions of the inhibition rates were significantly different （P=0.0062）. However, no significant change was seen in the distribution among the highest or the lowest inhibiting levels （〉95% and 〈30% inhibition rate）. And there were no significant differences （P 〉0.05） in events incidence, while gastra-intesternal bleeding decreased in co-administration of omeprazole.Conclusions Omeprazole significantly blunts clopidogreal efficacy while not exacerbates ischimic events in ACS undergoing PCI. Omeprazaole even can decrease gastra-intestinal bleeding in those patients.展开更多
文摘Background Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography （OCT） to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent （DES） implantation. Methods Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study. Results Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study： （1） superficial intimal tears （n=3）, （2） subintimal dissections （n=4）, （3） split of media （n=1）, （4） disruption of the fibrotic cap of plaque （n=1）. Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections （1.682±0.425 vs. 1.229±0.285, P=0.0290; 1.507±0.445 vs. 1.174±0.265, P=0.0072）. Conclusions The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.
文摘Background Omeprazole, usually used in the antiplatelet therapy during percutaneous coronary intervention （PCI） in acute coronary syndrome （ACS）, has been reported to increase ischemic events in retrospective studies. However, other clinical trials gave paradoxical results. The aim of this study was to assess the effects of omeprazole on clopidogrel efficacy and clinical events.Methods All patients （n=172） received aspirin （loading dose 300 mg and maintenance dose 100 mg/d） and clopidogrel （loading dose 600 mg and maintenance dose 75 mg/d） during the therapy. They were randomized to receive omeprazole （20 mg/d） or placebo for 30 days. Residual platelet activities in the adenosine 5＇-diphosphate （ADP） pathway were detected on the fifth day after PCI with thrombelastography （TEG）-mapping. The clinical events were recorded after one month.Results According to the five levels of platelet activities, the frequency distributions of the inhibition rates were significantly different （P=0.0062）. However, no significant change was seen in the distribution among the highest or the lowest inhibiting levels （〉95% and 〈30% inhibition rate）. And there were no significant differences （P 〉0.05） in events incidence, while gastra-intesternal bleeding decreased in co-administration of omeprazole.Conclusions Omeprazole significantly blunts clopidogreal efficacy while not exacerbates ischimic events in ACS undergoing PCI. Omeprazaole even can decrease gastra-intestinal bleeding in those patients.
