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
OBJECTIVES: The goal of this research was to clarify whether the benefit of reperfusion therapy for myocardial infarction was sustained long-term and to assess the gain in life expectancy by reperfusion therapy. BACKG...OBJECTIVES: The goal of this research was to clarify whether the benefit of reperfusion therapy for myocardial infarction was sustained long-term and to assess the gain in life expectancy by reperfusion therapy. BACKGROUND: Reperfusion therapy in acute myocardial infarction reduces infarct size and increases hospital survival. METHODS: We analyzed the 20-year outcome of 533 patients(mean age 56 years; 82%men) who were randomized to either reperfusion therapy or conventional therapy during the years 1981 to 1985. RESULTS: Mean follow-up was 21 years(range 19 to 23 years). At follow-up, 101 patients(36%) of the 269 patients allocated to reperfusion treatment and only 71 patients(26%) of the 264 conventionally treated patients were alive(p=0.02). The cumulative 10-, 15-, and 20-year survival rates were 69%, 48%, and 37%after reperfusion therapy and 59%, 38%, and 27%in the control group, respectively(p=0.005). Life expectancy of the reperfusion group was 15.2 years versus 12.4 years in the conventionally treated group(p< 0.0001). Myocardial re-infarction and subsequent coronary interventions were more frequent after reperfusion therapy, particularly during the first year. In multivariable analysis, reperfusion therapy was an important independent predictor of lower mortality at long-term follow-up(hazard ratio 0.7; 95%confidence interval 0.6 to 0.8). Other independent predictors of mortality were age, impaired left ventricular function, multivessel disease, infarct size, and inability to perform an exercise test at the time of discharge. CONCLUSIONS: This is the first study demonstrating sustained(20-year) improved survival after reperfusion therapy. The gain in life expectancy was almost three years, representing about one-third of the life-years lost by myocardial infarction.展开更多
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.
文摘OBJECTIVES: The goal of this research was to clarify whether the benefit of reperfusion therapy for myocardial infarction was sustained long-term and to assess the gain in life expectancy by reperfusion therapy. BACKGROUND: Reperfusion therapy in acute myocardial infarction reduces infarct size and increases hospital survival. METHODS: We analyzed the 20-year outcome of 533 patients(mean age 56 years; 82%men) who were randomized to either reperfusion therapy or conventional therapy during the years 1981 to 1985. RESULTS: Mean follow-up was 21 years(range 19 to 23 years). At follow-up, 101 patients(36%) of the 269 patients allocated to reperfusion treatment and only 71 patients(26%) of the 264 conventionally treated patients were alive(p=0.02). The cumulative 10-, 15-, and 20-year survival rates were 69%, 48%, and 37%after reperfusion therapy and 59%, 38%, and 27%in the control group, respectively(p=0.005). Life expectancy of the reperfusion group was 15.2 years versus 12.4 years in the conventionally treated group(p< 0.0001). Myocardial re-infarction and subsequent coronary interventions were more frequent after reperfusion therapy, particularly during the first year. In multivariable analysis, reperfusion therapy was an important independent predictor of lower mortality at long-term follow-up(hazard ratio 0.7; 95%confidence interval 0.6 to 0.8). Other independent predictors of mortality were age, impaired left ventricular function, multivessel disease, infarct size, and inability to perform an exercise test at the time of discharge. CONCLUSIONS: This is the first study demonstrating sustained(20-year) improved survival after reperfusion therapy. The gain in life expectancy was almost three years, representing about one-third of the life-years lost by myocardial infarction.
