Drug-eluting stents and acute myocardial infarction:A lethal combination or friends?

Primary percutaneous coronary intervention is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction(STEMI). First generation drug-eluting stents(DES),(sirolimus drug-eluting stents and paclitaxel drug-eluting stents), reduce the risk of restenosis and target vessel revascularization compared to bare metal stents. However, stent thrombosis emerged as a major safety concern with first generation DES. In response to these safety issues, second generation DES were developed with different drugs, improved stent platforms and more biocompatible durable or bioabsorbable polymeric coating. This article presents an overview of safety and efficacy of the first and second generation DES in STEMI.

Drug-eluting fully covered self-expanding metal stent for dissolution of bile duct stones in vitro

BACKGROUND The treatment of difficult common bile duct stones(CBDS)remains a big challenge around the world.Biliary stenting is a widely accepted rescue method in patients with failed stone extraction under endoscopic retrograde cholangiopancreatography.Fully covered self-expanding metal stent(FCSEMS)has gained increasing attention in the management of difficult CBDS.AIM To manufacture a drug-eluting FCSEMS,which can achieve controlled release of stone-dissolving agents and speed up the dissolution of CBDS.METHODS Customized covered nitinol stents were adopted.Sodium cholate(SC)and disodium ethylene diamine tetraacetic acid(EDTA disodium,EDTA for short)were used as stone-dissolving agents.Three different types of drug-eluting stents were manufactured by dip coating(Stent I),coaxial electrospinning(Stent II),and dip coating combined with electrospinning(Stent III),respectively.The drugrelease behavior and stone-dissolving efficacy of these stents were evaluated in vitro to sort out the best manufacturing method.And the selected stonedissolving stents were further put into porcine CBD to evaluate their biosecurity.RESULTS Stent I and Stent II had obvious burst release of drugs in the first 5 d while Stent III presented controlled and sustainable drug release for 30 d.In still buffer,the final stone mass-loss rate of each group was 5.19%±0.69%for naked FCSEMS,20.37%±2.13%for Stent I,24.57%±1.45%for Stent II,and 33.72%±0.67%for Stent III.In flowing bile,the final stone mass-loss rate of each group was 5.87%±0.25%for naked FCSEMS,6.36%±0.48%for Stent I,6.38%±0.37%for Stent II,and 8.15%±0.27%for Stent III.Stent III caused the most stone mass-loss no matter in still buffer or in flowing bile,which was significantly higher than those of other groups(P<0.05).In vivo,Stent III made no difference from naked FCSEMS in serological analysis(P>0.05)and histopathological examination(P>0.05).CONCLUSION The novel SC and EDTA-eluting FCSEMS is efficient in diminishing CBDS in vitro.When conventional endoscopic techniques fail to remove difficult CBDS,SC and EDTA-eluting FCSEMS implantation may be considered a promising alternative.

Drug-eluting balloons versus new generation drug-eluting stents for the management of in-stent restenosis: an updated meta-analysis of randomized studies

Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. Drug-eluting balloons (DEB) and new-generation DES had been available strategies in treatment of bare-metal stents/DES ISR (BMS/DES-ISR). Six new randomized trials have recently examined the angiographic outcomes and one-year clinical outcomes of DEB and new generation DES in BMS/DES-ISR. However, the optimal management for BMS/DES-ISR lesions remains controversial. Methods We searched the randomized clinical trials evaluating the angiographic outcomes and one-year clinical outcomes of DEB and new-generation DES in patients with BMS/DES-ISR. The primary endpoints were the angiographic outcomes, including the minimal luminal diameter (MLD), diameter stenosis %(DS%), late lumen loss (LLL), and binary restenosis (BR). Results A total of six randomized clinical trials with 1177 BMS/DES-ISR patients were included in our meta-analysis. For angiographic outcomes, there were significantly less MLD and more DS% with DEB compared to new-generation DES (MLD: MD =?0.18, 95% CI:?0.31– ?0.04, P < 0.001;DS%: MD = 5.68, 95% CI: 1.00–10.37, P < 0.001). Moreover, for one-year clinical outcomes, DEB was associated with a significant increase risk in target lesion revascularization (TLR)(RR = 2.93, 95% CI: 1.50–5.72, P = 0.002). However, DEB was associated with higher risks of major adverse cardiac event, target vessel revascularization, TLR, BR, and more DS% only in DES-ISR group. Conclusions DEB and new-generation DES have the similar clinical efficacy for the treatment of BMS-ISR. However, DES showed more MLD, less DS%, and a decreased risk of TLR for the treatment of DES-ISR.

Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease： a meta-analysis

BackgroundIt 仍然是争论的有 drug-eluting stent ( DES )的经皮的冠的干预是否与冠的动脉相比安全、有效为没有防卫的左主要冠的动脉( ULMCA )绕过接枝外科( CABG )疾病在长期列在后面在上面( 3 年) .MethodsEligible 研究被寻找 PubMed 选择， EMBASE ，并且 Cochrane 图书馆直到2016年12月6日。主要端点是一死亡，心肌的梗塞(MI ) 或在最长的后续期间的击合成。死亡，心脏的死亡， MI，击和重复 revascularization 是第二等的 outcomes.ResultsFour 使随机化的控制试用和包含 14,130 个病人的 12 调整观察研究被包括。DES 比得上关于主要端点的出现的 CABG (HR = 0.94， 95% CI：0.86-1.03 ) 。而且， DES 显著地与 MI 的更高的发生被联系(HR = 1.56， 95% CI：1.09-2.22 ) 并且重复 revascularization (HR = 3.09， 95% CI：2.33-4.10 ) 当没有差别在二策略之间被发现时，与 CABG 相比认为是死亡，心脏的死亡和击的率。而且， DES 能减少死亡， MI 或击的合成端点的风险(HR = 0.80， 95% CI：0.67-0.95 ) 因为有句法的 ULMCA 损害与重复 revascularization 的更高的风险获得 32 .ConclusionsAlthough，有 DES 的一种总线标准看起来象为 ULMCA 疾病在的 CABG 一样安全长期列在后面起来。另外，有 DES 的治疗能是到为 ULMCA 损害与的 CABG 的其他的 interventional 策略对中间的解剖复杂性低。

Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions

sTo 与大冠的 vessels.MethodsFrom 2004年4月为病人与赤裸金属的 stents ( BMS )相比评估 drug-eluting stents ( DES )的长期的安全和有效性到2006年10月， 2407 个连续病人经历 de novo 损害有比大或等于在在中国北京的 Fu Wai 医院的 3.5 公里的参考容器直径的经皮的冠的干预，有希望地被注册进这研究。我们包括死亡，心肌的梗塞(MI ) ，血栓，目标损害 revascularization (TLR ) ，目标容器 revascularization (TVR ) ，和主要不利心脏的事件获得了 9 年的临床的结果(向，死亡， MI，和 TVR 合成) 。我们执行了艇长比例危险的模型在倾向 match.ResultsAfter 倾向得分以后估计所有结果措施的相对风险， 514 个对待 DES 的病人被匹配到 514 个对待 BMS 的病人。与 BMS 对待的病人与 TLR 的更高的风险被联系(HR：2.55， 95%CI：1.520-4.277， P = 0.0004 ) 并且 TVR (HR：1.889， 95%CI：1.185-3.011， P = 0.0075 ) ，但是 death/MI 和向的率不是统计上不同的。所有学术研究协会定义 stent 血栓在 9 年在二 groups.ConclusionsDuring 是可比较的整个九年的长期的后续，在有大冠的动脉的病人的 DES 的使用仍然在 TLR 和 TVR 的风险与重要减小被联系。

Five-year clinical outcomes of first-generation versus second-generation drug-eluting stents following coronary chronic total occlusion intervention

Background There are limited data comparing long-term clinical outcomes between first-generation (1G) and second-generation (2G) drug-eluting stents (DESs) in patients who underwent successful percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) lesion. Methods A total of 840 consecutive patients who underwent PCI with DESs for CTO lesion from January 2004 to November 2015 were enrolled. Finally, a total of 324 eligible CTO patients received 1G-DES (Paclitaxel-eluting stent or Sirolimus-eluting stent, n = 157) or 2G-DES (Zotarolimus-eluting stent or Everolimus-eluting stent, n = 167) were enrolled. The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total repeat revascularization [target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR]. We investigated the 5-year major clinical outcomes between 1G-DES and 2G-DES in patient who underwent successful CTO PCI. Results After propensity score matched (PSM) analysis, two well-balanced groups (111 pairs, n = 222, C-statistic = 0.718) were generated. Up to the 5-year follow-up period, the cumulative incidence of all-cause death, re-MI, TLR, TVR and non-TVR were not significantly different between the two groups. Finally, MACE was also similar between the two groups (HR = 1.557, 95% CI: 0.820–2.959, P = 0.176) after PSM. Conclusions In this study, 2G-DES was not associated with reduced long-term MACE compared with 1G-DES following successful CTO revascularization up to five years.

Duration of dual antiplatelet treatment in the era of next generation drug-eluting stents

Current percutaneous coronary intervention guidelines recommend dual antiplatelets(aspirin 100 mg + clopidogrel 75 mg daily) for at least 12 mo following drugeluting stent(DES) implantation if patients are not at high risk of bleeding.Several reports have tried to shorten the dual antiplatelet therapy to 3-6 mo,especially following next-generation DES implantation,for cost-effectiveness.However,the clinical results are inconsistent and the data regarding next-generation DESs limited.In this report,recently published important pivotal reports regarding the optimal duration of dual antiplatelets following DES implantation are summarized.

Revisiting endovascular treatment in below-the-knee disease. Are drug-eluting stents the best option？

Patients with below-the-knee arterial disease are primarily individuals suffering from critical limb ischemia(CLI), while a large percentage of these patients are also suffering from diabetes or chronic renal failure or both. Available data from randomized controlled trials and their meta-analysis demonstrated that the use of infrapopliteal drug-eluting stents(DES), in short-to medium-length lesions, obtains significantly better results compared to plain balloon angioplasty and bare metal stenting with regards to vascular restenosis, target lesion revascularization, wound healing and amputations. Nonetheless, the use of this technology in every-day clinical practice remains limited mainly due to concerns regarding the deployment of a permanent metallic scaffold and the possibility of valid future therapeutic perspectives. However, in the majority of the cases, these concerns are not scientifically justified. Large-scale, multicenter randomized controlled trials, investigating a significantly larger number of patients than those already published, would provide more solid evidence and consolidate the use of infrapopliteal DES in CLI patients. Moreover, there is still little evidence on whether this technology can be as effective for longer below-the-knee lesions, where a considerable number of DES is required. The development and investigation of new, longer balloon-expanding or perhaps selfexpanding DES could be the answer to this problem.

Volumetric intravascular ultrasound comparisons of drug-eluting stent thrombosis and in-stent restenosis

Objectives We compared intravascular ultrasound (IVUS) findings of drug-eluting stent (DES)-treated lesions that developed stent thrombosis versus in-stent restenosis (ISR) to identify underlying mechanical differences. Methods IVUS findings in 15 post-DES thrombosis patients were compared with 45 matched ISR patients who had no evidence of stent thrombosis. Results Minimum stent area [MSA, (3.7±0.8) mm2 vs (4.9±1.8) mm2, P=0.01], minimum stent diameter [(1.9±0.3) mm vs (2.3±0.4) mm, P=0.005], mean stent area [(5.2±0.8) mm2 vs (7.2±2.1) mm2, P【0.01], and both focal [MSA/reference lumen area, (54.7±15.9)% vs (75.0±20.1)%, P=0.001] and diffuse stent expansion [mean stent area/reference lumen area, (76.6±23.0)% vs (110.3±23.3)%, P【0.01] were significantly smaller in the stent thrombosis group (vs the ISR group). An MSA 【4.0 mm2 (73.3% vs 35.6%, P=0.01) or 【5.0 mm2 (86.7% vs 53.3%, P=0.02) was more often found in the stent thrombosis group (vs the ISR group). The MSA site occurred more frequently in the proximal stent segment within the stent thrombosis group compared to the ISR group (60% vs 24.4%, P=0.01). There were no differences in edge dissection, stent fracture, or stent-vessel wall malapposition between the two groups. Independent predictors of stent thrombosis were diffuse stent expansion (OR=1.5, P=0.03) and proximal location of the MSA site (OR=12.7, P=0.04). Conclusion DES-treated lesions that develop thrombosis or restenosis are often underexpanded. Underexpansion appears to be more severe in DES-thrombosis lesions. Lesions with diffuse underexpansion and a proximal (vs distal) underexpanded MSA site are more predisposed to thrombus formation than ISR.

Immediate and mid-term outcomes of drug-eluting stent in treatment of coronary artery stenosis with very long defuse lesions

Objectives To evaluate the feasibility, and immediate and mid-term outcomes of drug-eluting stents (DESs) in the treatment of coronary artery stenosis with very long defuse lesions(VLDL). Methods Inclusion criteria:

Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation

Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P【0.01], plaque burden [(52±12)% vs (36±15)%, P【0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P【0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P【0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P【0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P【0.01) and residual plaque burden≥50% (OR=7.3, P【0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.

Successful Percutaneous Treatment of Coronary Artery Ectasia with Drug-Eluting Stent

Coronary artery ectasia is well-known but relatively uncommon finding with prevalence ranging from 1.2% to 5.3%. Coronary artery ectasia has been associated with atherosclerosis in approximately half of the cases. Here, we are presenting a case of male patient who experienced myocardial infarction and was diagnosed with coronary artery ectasia in proximal-mid junction of left anterior descending artery with stenotic lesion. The patient was successfully treated with percutaneous transluminal coronary angioplasty.

COMPARISON OF SHORT- AND LONG-TERM OUTCOMES BETWEEN CYPHER AND TAXUS DRUG-ELUTING STENTS FOR IN-STENT RESTENOSIS

Objective To compare the short- and long-term clinical outcomes between sirolimus-eluting stent (Cypher stent) and paclitaxel-eluting stent (TAXUS stent) in patients with in-stent restenosis (ISR) lesions of the coronary arteries.Methods From December 2002 to March 2005, 253 patients with ISR lesions of the coronary arteries were selected and divided into two groups. Cypher group (152 cases) was treated with Cypher or Cypher Select stents, and TAXUS group (101 cases) with TAXUS stents. A total of 262 ISR lesions in these patients were treated with 308 drug-eluting stents (DESs), including 176 Cypher or Cypher Select stents and 132 TAXUS stents. All patients were followed up for 10 months. Procedure success rates of DES implantation in both groups were observed. Major adverse cardiac events (MACE) rates in hospital and at 10 months follow-up, as well as in-DES restenosis observed using coronary angiography at follow-up were compared between two groups. Results Success rate of DES implantation was 100% in both groups. No significant difference in MACE rate during hospitalization was found between the two groups. However, at 10 months follow-up, MACE rate was higher in TAXUS group than in Cypher group (16.00% vs. 6.67%, P=0.031). As for coronary angiography at 10 months follow-up, we observed an increasing tendency of in-DES restenosis rate in TAXUS group compared with Cypher group (29.41% vs. 14.04%, P=0.075). Conclusions Cypher and TAXUS DESs both have good short- and long-term outcomes in treating ISR. Cypher DES proved better long-term clinical outcome than TAXUS DES.

Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent era

为与钙化的冠的损害在病人与旋转 atherectomy ( RA )相结合的 drug-eluting stent ( DES )的 BackgroundAlthough 光线的存取可以与主要流血复杂并发症的更低的风险被联系并且与大腿骨的存取相比获得有利临床的结果，这条途径的长期的结果数据在当代的 DES era.Methods &#x00026 被限制；ResultsThis 回顾的学习寻求了为在 126 个连续病人经由 transradial (TR ) 和 transfemoral (TF ) 线路经历 RA 的病人比较在里面医院和长期的结果(59 光线， 67 大腿骨) 从 2009 ～ 2014。TR RA 过程被三个 TR 操作员在 44/62 (71%) 执行，与由在现在的学习的四个 TF 操作员的 15/64 (23%) 相比。Signi&#x0fb01； cantly 更小的直径指南导管和辘辘声(1.39 &#x000b1；0.16 公里对 1.53 &#x000b1；0.24 公里， P = 0.001 ) 在 TR 组被使用。程序的成功率在 TR 和 TF 组是类似的。有一显著地，赞成光线的动脉的不太主要的存取地点流血复杂并发症存取(2% 对 16% ， P = 0.012 ) 。在里面医院死亡或心肌的梗塞的发生在两个组是低的。尽管更低的不利事件率的一个趋势与 TF 那个相比在 TR 组被表明，没有统计意义(21%对27%， P = 0.135 )是 detected.ConclusionsRadial 存取，为 RA 和 DES 的大腿骨的存取的一种有用选择，能安全地并且成功地与由富有经验的 TR 操作员需要 RA 的重重地钙化的冠的损害在多达71%病人上被执行。

Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents:A Meta-analysis and Systematic Review

Objective The benefit of short-term dual antiplatelet therapy(DAPT) following second-generation drug-eluting stents implantation has not been systematically evaluated. To bridge the knowledge gap,we did a meta-analysis to assess the efficacy of ≤6 months versus ≥12 months DAPT among patients with second-generation drug-eluting stents. Methods We searched online databases and identified randomized controlled trials that assess the clinical impact of short-term DAPT(≤6 months) published before March 3,2016. The efficacy endpoints included the incidence of all-cause death,myocardial infarction,cerebrovascular accidents,and definite or probable stent thrombosis. Safety endpoint defined as major bleeding was also evaluated and discussed. Results We included 5 trials that randomized 9473 participants(49.8%,short-term DAPT duration vs. 50.2%,standard duration). A total of 9445(99.7%) patients reported the efficacy endpoints,and the safety endpoint was available from 4 studies(n=8457). There was no significant difference in efficacy endpoints between short-term and standard DAPT duration(≥12 months) [risk ratio(RR) 0.96; 95% confidence intervals(CI),0.80-1.15]. Short-term DAPT duration did not significantly increase the individual risk of all-cause death,myocardial infarction,cerebrovascular accidents,or definite or probable stent thrombosis. Although short-term DAPT obviously reduced risk of major bleeding compared with standard DAPT(RR 0.53; 95% CI,0.29-0.96),significant publication bias was found when accessing the safety endpoint of the 4 studies(Egger's test,P=0.009). Conclusions The efficacy of short-term DAPT was comparable with that of standard duration DAPT.DAPT less than 6 months may be appropriate for patients receiving second-generation drug-eluting stents implantation.

Are Newer-Generation Drug-Eluting Stents More Effective in Women than Early-Generation Ones?

Evidence-based research is increasingly aimed at differentiating between no proof of difference (failed demonstration of superiority) and proof of no difference (demonstration of equivalence). The latter requires that equivalence margins are incorporated in the analysis of outcomes. We applied an analysis of equivalence to study the incremental benefit of newer-generation vs early-generation drug-eluting stents (DES) in women receiving percutaneous coronary intervention. The clinical material was derived from published data. Our equivalence testing was focused on the end-point of target-lesion revascularisation (TLR). Results were expressed as rate differences (RDs), while the equivalence margins (±2.9%) were derived from the statistical power calculations of a recent trial. Our results clearly indicated that, in women, there was an equivalent effectiveness between newer-generation and early-generation of DES.

Drug-Eluting Stent for the Treatment of Early Fistula Failure

Introduction: Morbidity and mortality in chronic haemodialysis patients is related to dialysis efficiency. Several complications may occur with vascular access, usually associated with a stenosis. This is known to occur frequently in the venous outflow. Stenosis of the arterial side is not as frequently discussed, but it is also likely to compromise fistula function. Traditionally, surgical and percutaneous interventions have been used to treat failing fistulas, but the employment of drug-eluting stents for the treatment of failing fistulas due to the arterial stenosis has been described rarely. Methods: A 65-year-old male patient referred to our ambulatory because of hand ischemia during haemodialysis treatments only few days after radial-cephalic fistula creation. After physical and echo-color-doppler examination, angiography was performed and percutaneous intervention was proposed. After the positioning of a guiding catheter, the lesion was crossed with a 0.014” guide wire followed by direct drug-eluting stent implantation. Results: Final angiogram showed a good result and a preserved flow through the fistula. Six months later the patient was asymptomatic and the fistula was still working. Conclusion: Although further prospective studies are necessary, percutaneous transluminal angioplasty (PTA) with drug-eluting stents implantation could be considered a safe and effective technique for the treatment of arteriovenous fistulas stenosis.

Giant Coronary Artery Pseudoaneurysm after Drug-Eluting Stent Implantation

Formation of coronary artery pseudoaneurysm after percutaneous coronary intervention is rarely reported. A close review of available literature indicates a trend of growing incidence in recent times. Here, we present a case of coronary pseudoaneurysm developing in the left circumflex artery within 50 days of sirolimus-eluting stent implantation in a 47-year-old man who was treated for triple-vessel coronary artery disease. Initially, the patient refused any further treatment. However, considering the rapid growth of pseudoaneurysm and increased severity of symptoms at subsequent follow-up, we decided to treat giant pseudoaneurysm with embolization coils. The procedure was successful and the patient remained asymptomatic thereafter.

Clinical significance of provoked coronary spasm at chronic stage in patients who underwent successful complete coronary revascularization with first-generation drug-eluting stents

Background: Provoked spasm might have influence on cardiovascular events even after successful DES implantation. Methods and results: A consecutive 122 patients who underwent first-generation DES (CypherTM, and TaxusTM) implantation and had no residual stenosis at follow-up coronary angiography were included. All patients also underwent acetylcholine provocation test (ACh) at follow-up angiography. Age, sex, coronary risk factors (smoking, hypertension, diabetes mellitus, dyslipidemia), medication (calcium channel blockers, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, nitrates, β blockers, statins), duration from stent implantation to follow-up angiography (15.5 ± 14.5 months), old myocardial infarction, Ach + were included as variables for multivariate analysis for cardiovascular events (angina pectoris without intervention, target lesion revascularization, acute myocardial infarction, definite or probable stent thrombosis, cardiac death, and stroke). ACh provocation test was positive in 64.8%. The following events occurred during a mean follow-up period of 26.9 ± 9.5 months;angina pectoris without intervention in 12, very late stent thrombosis in 1, acute myocardial infarction in 1, sudden death in 1, and stroke in 4. By Adjusted Cox hazard model, age was the independent predictor of future cardiovascular events. ACh was unbalanced data for Cox hazard model, and by logistic regression model, ACh was the strongest predictor. Conclusions: Coronary endothelial dysfunction at chronic stage is the strongest predictor of further prognosis in patients with first-generation DES.