Background-Observed rates of restenosis after drug-eluting stenting are low(< 10%). Identification of a reliable and powerful angiographic end point will be useful in future trials. Methods and Results-Late loss(po...Background-Observed rates of restenosis after drug-eluting stenting are low(< 10%). Identification of a reliable and powerful angiographic end point will be useful in future trials. Methods and Results-Late loss(postprocedural minimum lumen diameter minus 8-month minimum lumen diameter) was measured in the angiographic cohorts of the SIRIUS(n=703)-and E-SIRIUS(n=308) trials. Two techniques, the standard normal approximation and an optimized power transformation, were used to predict binary angiographic restenosis rates and compare them with observed restenosis rates. The mean instent late loss observed in the SIRIUS trial was 0.17±0.45 mm(sirolimus) versus 1.00±0.70 mm(control). If a normal distribution was assumed, late loss accurately estimated in-stent binary angiographic restenosis for the control arm(predicted 35.4%versus observed 35.4%) but underestimated it in the sirolimus arm(predicted 0.6%versus observed 3.2%). Power transformation improved the reliability of the estimate in the sirolimus arm(predicted 3.2%[CI 1.0%to 6.7%]) with similar improvements in the E-SIRIUS trial(predicted 4.0%[CI 1.2%to 7.0%] versus observed 3.9%). In the sirolimus-eluting stent arm, in-stent late loss correlated better with target-lesion revascularization than in-segment late loss(c-statistic=0.915 versus 0.665). Conclusions-Because distributions of late loss with a low mean are right-skewed, the use of a transformation improves the accuracy of predicting low binary restenosis rates. Late loss is monotonically correlated with the probability of restenosis and yields a more efficient estimate of the restenosis process in the era of lower binary restenosis rates.展开更多
Objective: To disclose possible influences of alcoholic beverages on restenosi s rate in men with coronary artery disease treated with percutaneous translumina l coronary angioplasty (PTCA) and stent implantation. Des...Objective: To disclose possible influences of alcoholic beverages on restenosi s rate in men with coronary artery disease treated with percutaneous translumina l coronary angioplasty (PTCA) and stent implantation. Design: Retrospective coho rt study. Patients: 225 consecutive male patients underwent PTCA and stent impla ntation. All patients had a control angiography and were contacted for a questio nnaire regarding their drinking habits. Main outcome measures: Mean late loss of luminal diameter, rate of coronary restenosis of 50%or more within the stented segment, and rate of repeat angioplasty. Results: 53 patients (with 80 stents) consumed< 50 g of alcohol a week and 172(with 266 stents) consumed more (50-700 g a week). Baseline characteristics were similar in both groups except for a hi gher prevalence of reduced cardiac function and multivessel disease and a lower high density lipoprotein cholesterol concentration among patients who consumed l ittle or no alcohol. Patients who consumed ≥50 g alcohol a week had a lower mea n late loss of the luminal diameter (1.1 (0.79)mm v 1.45 (0.82) mm, p=0.002), a lower rate of coronary restenosis within the stented segment (33.7%v 48.8%, p= 0.001), and a lower rate of repeat angioplasty(23.3%v 42.5%, p=0.002). In mult ivariate analysis, only alcohol consumption and diabetes were independent and si gnificant discriminators for late loss of luminal diameter (p=0.005 and p=0.01, respectively), restenosis(odds ratio 0.54 and 2.08, respectively), and repeat an gioplasty(odds ratio 0.39 and 2.18, respectively). Conclusion: Alcohol intake is associated with reduced restenosis after PTCA and stent implantation.展开更多
减少 PTCA 后冠脉再狭窄的有前途的新方法是植入血管内支架。这一原则是 Dotter 1969年首先提出的近年来在动物实验中使用了温度变形记忆合金、钢制可扩张螺旋、可扩张不锈钢支架和可扩张编织的不锈钢网等。最近在人体中也开始植入血管...减少 PTCA 后冠脉再狭窄的有前途的新方法是植入血管内支架。这一原则是 Dotter 1969年首先提出的近年来在动物实验中使用了温度变形记忆合金、钢制可扩张螺旋、可扩张不锈钢支架和可扩张编织的不锈钢网等。最近在人体中也开始植入血管内支架来防止 PTCA 后再狭窄。本文对11例植入血管内支架后即刻和3个月后冠脉造影结果进行了定量研究。本文11例,年龄41～69岁(平均55岁),男性8例。分别来自3个医学中心(法国、荷兰)。施术处9例为前降支,2例为左旋支。血管内支架是 Medinvent SA 制造的,用外科级不锈钢编织成网状,共16圈,每圈宽0.08mm,展开更多
文摘Background-Observed rates of restenosis after drug-eluting stenting are low(< 10%). Identification of a reliable and powerful angiographic end point will be useful in future trials. Methods and Results-Late loss(postprocedural minimum lumen diameter minus 8-month minimum lumen diameter) was measured in the angiographic cohorts of the SIRIUS(n=703)-and E-SIRIUS(n=308) trials. Two techniques, the standard normal approximation and an optimized power transformation, were used to predict binary angiographic restenosis rates and compare them with observed restenosis rates. The mean instent late loss observed in the SIRIUS trial was 0.17±0.45 mm(sirolimus) versus 1.00±0.70 mm(control). If a normal distribution was assumed, late loss accurately estimated in-stent binary angiographic restenosis for the control arm(predicted 35.4%versus observed 35.4%) but underestimated it in the sirolimus arm(predicted 0.6%versus observed 3.2%). Power transformation improved the reliability of the estimate in the sirolimus arm(predicted 3.2%[CI 1.0%to 6.7%]) with similar improvements in the E-SIRIUS trial(predicted 4.0%[CI 1.2%to 7.0%] versus observed 3.9%). In the sirolimus-eluting stent arm, in-stent late loss correlated better with target-lesion revascularization than in-segment late loss(c-statistic=0.915 versus 0.665). Conclusions-Because distributions of late loss with a low mean are right-skewed, the use of a transformation improves the accuracy of predicting low binary restenosis rates. Late loss is monotonically correlated with the probability of restenosis and yields a more efficient estimate of the restenosis process in the era of lower binary restenosis rates.
文摘Objective: To disclose possible influences of alcoholic beverages on restenosi s rate in men with coronary artery disease treated with percutaneous translumina l coronary angioplasty (PTCA) and stent implantation. Design: Retrospective coho rt study. Patients: 225 consecutive male patients underwent PTCA and stent impla ntation. All patients had a control angiography and were contacted for a questio nnaire regarding their drinking habits. Main outcome measures: Mean late loss of luminal diameter, rate of coronary restenosis of 50%or more within the stented segment, and rate of repeat angioplasty. Results: 53 patients (with 80 stents) consumed< 50 g of alcohol a week and 172(with 266 stents) consumed more (50-700 g a week). Baseline characteristics were similar in both groups except for a hi gher prevalence of reduced cardiac function and multivessel disease and a lower high density lipoprotein cholesterol concentration among patients who consumed l ittle or no alcohol. Patients who consumed ≥50 g alcohol a week had a lower mea n late loss of the luminal diameter (1.1 (0.79)mm v 1.45 (0.82) mm, p=0.002), a lower rate of coronary restenosis within the stented segment (33.7%v 48.8%, p= 0.001), and a lower rate of repeat angioplasty(23.3%v 42.5%, p=0.002). In mult ivariate analysis, only alcohol consumption and diabetes were independent and si gnificant discriminators for late loss of luminal diameter (p=0.005 and p=0.01, respectively), restenosis(odds ratio 0.54 and 2.08, respectively), and repeat an gioplasty(odds ratio 0.39 and 2.18, respectively). Conclusion: Alcohol intake is associated with reduced restenosis after PTCA and stent implantation.
文摘减少 PTCA 后冠脉再狭窄的有前途的新方法是植入血管内支架。这一原则是 Dotter 1969年首先提出的近年来在动物实验中使用了温度变形记忆合金、钢制可扩张螺旋、可扩张不锈钢支架和可扩张编织的不锈钢网等。最近在人体中也开始植入血管内支架来防止 PTCA 后再狭窄。本文对11例植入血管内支架后即刻和3个月后冠脉造影结果进行了定量研究。本文11例,年龄41～69岁(平均55岁),男性8例。分别来自3个医学中心(法国、荷兰)。施术处9例为前降支,2例为左旋支。血管内支架是 Medinvent SA 制造的,用外科级不锈钢编织成网状,共16圈,每圈宽0.08mm,
