Real-world five-year outcomes of FlexyRap®cobalt-chromium rapamycin-eluting stents with biodegradable polymer in patients with de-novo coronary artery disease

BACKGROUND The use of biodegradable polymer drug-eluting stents(BP-DES)has been proven to minimize restenosis and stent thrombosis.The current post-marketing monitoring was observed at the 5-year clinical outcomes of individuals who had been treated with FlexyRap®DES in the real world.AIM To assess the safety and effectiveness of FlexyRap®DES at the 5-year follow-up in real-world settings.METHODS Findings from a retrospective,multi-center,observational,post-market clinical follow-up study of patients treated with FlexyRap®DES for de novo coronary artery disease(CAD)were reported.During the 12-mo follow-up,the primary endpoint was target lesion failure,which was defined as the composite of cardiovascular death, target vessel myocardial infarction(TV-MI), and clinically driven target lesion revascularization.RESULTS The data of 500 patients received with FlexyRap®DES was obtained at the completion of the surveillance timeline of 5-year.After the implantation of FlexyRap®DES,the device success rate was 100%.Adverse events that led to major bleeding,permanent disability,or death were not experienced in the patients.The major adverse cardiac event rate at 12-mo,3-year,and 5-year follow-up was 1(0.2%),0(0%),and 1(0.2%)respectively with 0(0%)cardiovascular death,2(0.4%)TV-MI,and 0(0%)TLR compositely.Furthermore,late stent thrombosis was found in 2(0.4%)patients at the follow-up of 12-mo,very late stent thrombosis was observed in 2 patients(0.4%)at 3-year follow-up.CONCLUSION FlexyRap®DES was proved to be safe and efficacious in real-world patients with de novo CAD,indicating a lowered rate of cardiac events and stent thrombosis at 5-year follow-up.

Role of Second-Generation Drug-Eluting Stents and Bypass Grafting in Coronary Artery Disease:A Systematic Review and Meta-analysis

Background:The safety and efficacy of coronary artery bypass grafting(CABG)and second-generation drug-eluting stents(DESs)in patients with coronary artery disease(CAD)remain controversial.Therefore we aimed to compare the outcomes of CAD patients treated with CABG and second-generation DESs.Methods:We systematically searched the PubMed,Cochrane Library,Ovid,and Elsevier databases.Studies comparing second-generation DESs with CABG in CAD patients were included.RevMan 5.3 was used to extract and pool the data from the applicable studies.Results:Six trials(N=6604 participants)were included in this meta-analysis.Among all of the CAD patients,second-generation DESs were associated with no differences in the risks of all-cause death[risk ratio(RR)1.18,95% confi dence interval(CI)0.98–1.43,P=0.09],cardiovascular death(RR 1.14,95% CI 0.81–1.59,P=0.45),myocardial infarction(RR 1.22,95% CI 0.98–1.54,P=0.08),and stroke(RR 0.83,95% CI 0.59–1.17,P=0.29),but increased the risks of revascularization(RR 1.95,95% CI 1.66–2.30,P<0.001)and major adverse cardiac and cerebrovascular events(RR 1.72,95% CI:1.31–2.26,P<0.001)when compared with CABG.Conclusions:In the treatment of CAD patients,second-generation DESs was not associated with increased risks of all-cause death,cardiovascular death,myocardial infarction,and stroke,but increased the risks of revascularization and major adverse cardiac and cerebrovascular events when compared with CABG.

Clinico-Angiographic Profile and Prevalence of Restenosis in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty to Left Main Coronary Artery: An Observational Cohort Study

Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to assess the clinical profile, angiographic status, and prevalence of restenosis in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in LMCA. Materials and Methods: This observational cohort study included 17 patients who underwent PTCA in LMCA during one-year study period at tertiary care centers in Government Medical College, Kozhikode, India. Data including various risk factors, clinical and angiographic details, stent used, procedural complications and outcomes including rate of restenosis were analyzed. Results: A total of 17 patients (mean age 53.88 ± 9.80 years) with 76.47% of males were included in the study. Smoking and hypertension were the most common risk factors presented in 52.94% and 47.06% of patients respectively. Single vessel disease (SVD) of LMCA was the most common pattern observed in 47.10%;the rate of restenosis was observed in 11.76% patients. Revascularization was performed in one patient (5.88%) with coronary artery bypass graft and in one patient (5.88%) with PTCA using drug eluting stent (DES). The overall procedural success was 88.24% in this study. Survival rate was 100% at one-year follow-up period. Conclusion: Our study involved patients who underwent PTCA in LMCA, showed smoking as a most prevalent risk factor for coronary artery disease and SVD as a most common pattern, comparatively low rate of restenosis and 100% of survival rate at one-year follow-up period.

One-year outcomes of a Neo Hexa sirolimus-eluting coronary stent system with a biodegradable polymer in all-comers coronary artery disease patients: Results from Neo Registry in India

BACKGROUND Biodegradable polymer drug-eluting stents(BP-DES)have shown to reduce restenosis rates and have low rates of stent thrombosis.The present postmarketing surveillance assessed 1-year clinical outcomes of patients who had received Neo Hexa DES in real practice.AIM To investigate 1-year clinical outcomes of Neohexa DES in real practice.METHODS Data obtained from a single-center cohort of patients who had received Neo Hexa stents as part of routine treatment of coronary artery disease(CAD)were retrospectively investigated.The primary study endpoint was the rate of major adverse cardiac events(MACEs)defined as the composite of death,myocardial infarction(MI),and target lesion revascularization(TLR)during the follow-up at1 mo,6 mo,and 1 year after the index procedure.RESULTS A total of 129 patients with 172 lesions were enrolled.The most common comorbid conditions were hypertension(49.61%)and diabetes mellitus(39.53%).Procedural success was achieved in all patients,and no in-hospital MACE was reported.The incidence of composite MACE at 30 d,6 mo,and 1 year was 0.78%,3.94%,and 4.87%,respectively.The rate of possible and probable late stent thrombosis was 0.78%.The cumulative incidences of death,MI,and TLR at 1 year were 2.44%,0.81%,and 1.63%,respectively.CONCLUSION The relatively low rates of MACE and stent thrombosis in this study support safety and performance of Neo Hexa stents,suggesting it to be an effective alternative to other contemporary stents for the treatment of de novo lesions in native coronary arteries.

Genetics of coronary artery disease and myocardial infarction

Atherosclerotic coronary artery disease(CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction(MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MIassociated genetic variants identified using candidate gene approaches and genome-wide association studies(GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI.

Sirolimus-eluting Stent for the Treatment of Small Coronary Artery Lesions:Comparison between Cypher and Firebird Stent

Objectives To evaluate the effectiveness of firebird stent for the treatment of coronary de novo lesion compared with cypher stent. Methods Ninety-one consecutive patients with 156 lesions who underwent coronary cypher (n = 68 lesions) and firebird (n = 88 lesions) implantation, quantitative coronary angiography (QCA) was performed at the time of stent implantation and subsequently at 8 months post-stenting. Small vessel disease was defined as ≤2.5 mm of reference vessel diameter measured by QCA. Major adverse cardiac events (MACE) including death, thrombosis, nonfatal myocardial infarction and target lesion revascularization (TLR) were compared between the two groups. Results Baseline clinical characteristics and angiographic parameters were similar between the two groups. Seven-month angiographic follow-up, the late loss was not different between the two groups (0.14 ± 0.38 mm vs 0.13 ± 0.17 mm, P > 0.05). Similarly, overall thrombosis rate were similar in both groups (1.5% vs 1.1%, P > 0.05). However, in-stent restenosis as well as in-segment restenosis rate were significantly higher in cypher group than that in firebird group (4.4% vs 0% and 19.1% vs 3.4%, P = 0.047 and P = 0.001 respectively). TLR was also higher in the cypher group (10.3% vs 2.3%, P = 0.033) compared with firebird group. Conclusions In this small sample size, non-randomized study, the data indicated that implantation of firebird stent for the treatment of small coronary lesion showed more favorable results in respective of restenosis compared with cypher stent implantation. A multi-center, large-sample size, randomized study, therefore, may be warranted.

Comparison of the Efficacy of Drug-eluting Stents Versus Bare-metal Stents for the Treatment of Left Main Coronary Artery Disease

treatment of left main coronary artery （LMCA） disease in select patients. However, it is unclear whether drug-eluting stents （DESs） have better outcomes in patients with LMCA disease compared with bare-metal stent （BMS） during long-term follow-up in Chinese populations. Methods： From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups： 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events （MACEs）, including cardiovascular （CV） death, myocardial infarction （MI）, and target lesion revascularization （TLR） at 5 years postimplantation. Results： Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE （19.4% vs. 31.8%, P = 0.022）, CV death （7.0% vs. 14.7%, P = 0.045）, and MI （5.4% vs. 12.4%, P = 0.049） than the BMS group. There were no significant differences in the rate of TLR （10.9% vs. 17.8%, P = 0.110） and stent thrombosis （4.7% vs. 3.9%, P = 0.758）. The rates of MACE （80.6% vs. 68.2%, P = 0.023）, CV death （93.0% vs. 85.3%, P - 0.045）, TLR （84.5% vs. 72.1%, P = 0.014）, and MI （89.9% vs. 80.6%, P = 0.029） free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and M1 were 0.41 （95% confidence interval [C/l： 0.21-0.63, P = 0.029） and 0.29 （95% CI： 0.08-0.92, P = 0.037）, respectively. Conelusions： DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.

Nine-month Angiographic and Two-year Clinical Follow-up of Novel Biodegradable-polymer Arsenic Trioxide-eluting Stent Versus Durable-polymer Sirolimus-eluting Stent For Coronary Artery Disease

Background:Despite great reduction of in-stent restenosis,first-generation drug-eluting stents (DESs) have increased the risk of late stent thrombosis due to delayed endothelialization.Arsenic trioxide,a natural substance that could inhibit cell proliferation and induce cell apoptosis,seems to be a promising surrogate of sirolimus to improve DES performance.This randomized controlled trial was to evaluate the efficacy and safety of a novel arsenic trioxide-eluting stent (AES),compared with traditional sirolimus-eluting stent (SES).Methods:Patients with symptoms of angina pectoris were enrolled and randomized to AES or SES group.The primary endpoint was target vessel failure (TVF),and the second endpoint includes rates of all-cause death,cardiac death or myocardial infarction,target lesion revascularization (TLR) by telephone visit and late luminal loss (LLL) at 9-month by angiographic follow-up.Results:From July 2007 to 2009,212 patients were enrolled and randomized 1 ∶1 to receive either AES or SES.At 2 years of follow-up,TVF rate was similar between AES and SES group (6.67％ vs.5.83％,P =0.980).Frequency of all-cause death was significantly lower in AES group (0 vs.4.85％,P =0.028).There was no significant difference between AES and SES in frequency of TLR and in-stent restenosis,but greater in-stent LLL was observed for AES group (0.29 ± 0.52 mm vs.0.1 0 ± 0.25 mm,P =0.008).Conclusions:After 2 years of follow-up,AES demonstrated comparable efficacy and safety to SES for the treatment of de novo coronary artery lesions.

Age-based clinical and angiographic outcomes after sirolimus-eluting stent implantation in patients with coronary artery disease

Background Advanced age independently predicts early and late mortality and major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI）. Randomized clinical trials indicate that siroUmus-eluting stent （SES） implantation reduces target lesion revascularization （TLR）, but there are limited data on the impact of age on outcomes following SES implantation in patients with coronary artery disease （CAD） in real-world practice. Methods A total of 333 CAD patients with 453 lesions were enrolled in this study. Subjects were divided into two groups according to age： a young group （〈65 years old, 244 patients with 369 lesions） and elderly group （≥65 years old, 89 patients with 113 lesions）. Clinical follow-up and quantitative coronary angiography （QCA） were performed seven months after PCh Results Baseline clinical, demographic, angiographic, and procedural chararcteristics were similar in both groups, except that there were more female patients in the elderly group （21.3% vs 9.8%, P=-0.006）. Primary success rate was similar in both groups （96.5% in young group vs 95.7% in elderly group, P〉0.05）. During angiographic follow-up at 7 months, binary in-stent restenosis and in-segment restenosis rates were not significantly different between the two groups （4.7% vs 1.8%; 9.7% vs 8.8%, P〉0.05 respectively）. Both sub-acute and late thrombosis rates were similar in the two groups （0.3% vs 0.9% and 1.2% vs 0.9%, P〉0.05 respectively. TLFI was not significantly different between the two groups （6.5% vs 3.5%;P=-0.246）. The rates of bleeding, stroke, angina rehospitalization during the, follow-up period were also similar in both groups （P〉0.05 respectively）. Conclusion Despite a high-risk clinical profile, coronary SES implantation can be safely and effectively performed in elderly patients with a similar procedural success rate, a low complication rate, and excellent 7-month outcomes.

Comparison of pre-dilation with a non-compliant balloon versus a dual wire scoring balloon for coronary stenting

Purpose: The aim of this study was to determine the influence of lesion preparation using the dual wire scoring balloon on stent expansion and long-term outcomes. Methods: Forty-six consecutive de novo lesions treated with a single >2.5 mm drug-eluting stent under intravascular ultrasound guidance, using two implantation strategies, were randomly assigned to: 1) pre-dilation with a non-compliant balloon (NC group;n = 23) or 2) pre-dilation with a dual wire scoring balloon (DS group;n = 23). Results: Although the balloon size and the maximal dilation pressure for pre-dilatation was larger (3.33 ± 0.28 vs 3.09 ± 0.33 mm, p = 0.01) and higher (11.6 ± 3.2 vs 8.6 ± 2.7 atm,

CLINICAL APPLICATION oF TEN TYPES OF INTRACORONARY STENTS

Prom April 1993 to December 1997.42 intracoronary stents of ten typeswere implanted in 40 patients with coronary artery disease.Of the 42stents,33(78.6%)wre implanted in LAD,2(4.8%)in LCX and 7(16.7%)inRCA.which included Cordis stent,Gianturco-Roubin stent,Nir stent,Wiktor stent,Angiostent and Be stent.etc.The success rate of stentimplantation was 100%.The stenostic percentage was reduced from 90.2%pre-operation to 4.5±8.2% post-operation and the average minimumdiamter of the vessels was increased from 0.35mm to 3.44mm.Subacutestent thrombosis occured in 2 patients because of inadequate anti-coagulant therapy.During 1-32 months follow-up,8 patienta developedrecurrent angine of whom 4 were showed restenosis by angiographicevidence.We concluded that selection of suitable stents acccrding tothe characteristics of lesions and administration of appropriateanticoagulant therapy are critical to successful stent implantation.

CLINICAL APPLICATION OF INTRACORONARY STENTING

Intracoronary stents were implanted in 61 patients(58 males and 3females,aged 52.1±8.3 years) with coronary heart disease in thishospital from June 1995 to May 1998.Seventy-two intracoronary stents (12Palmaz-Schatz.8 OR-I,45 Multilink,6 NIR and 1 Wiktor-i) were implanted,45 in LAD(62.5% ),22 in RCA(30.6%) and 5 in LCX(6.9%),Indications forstenting included 30 de novo(41.6%).4 bail-out(5.6%)and 38 Suboptimal(52.8%)stenting.The procedure success rate was 100%.Averagediameterstenosis decreased from 75-100% to -10-10% after stenting.There was one death from subacute stent thrombosis Two cases hadhematoma at the pancture site.There were no complication of acutethrombosis,cerebral hemorrhage and emergency CABG.During 1-36 monthsfollow-up,6 cases had relapse of chest pain,incinding 4 case ofrestenosis proved by argiography.Coronary stenting is a successfulmeans for atent"stand-by" and bail-out procedure for balloon angioplasty.Optimal angiographic results can be achieved in the majority ofpatients by proper stent sizing and deployment techniques.Anticoagulation should be given according to the characteristics oflesions and post-stenting angiographic findings so as to reducevascular and bleeding complications as well as hospital stay followingcoronary angioplasty.The results suggest that intracoronary stentinghas high success rate and low restenosis rate.It is an effective andsafe interventional therapy for acute coronary closure or selected denovo complex lesions following PTCA.

Inflammatory response, drug-eluting stent and restenosis

Cardiovascular diseases are the major cause of mortality in the Western world and it is expected that this will rem-ain so during the foreseeable future. 1 Among them, coronary artery disease （CAD） is the most important underlying cause of death due to cardiovascular disease.^2 Current treatment of pattents with CAD includes mainly risk factor management, drug therapy and revascularization techniques.

A single center investigation of bare-metal or drug-eluting stent restenosis from 1633 consecutive Chinese Han ethnic patients

Background Stents are widely used in China but the clinical impression is somehow that restenosis is less common because of the lower prevalence of coronary artery disease （CAD） and associated risk factors in Chinese populations. However, no large-sample published studies are available on angiographic stent restenosis including those of bare-metal stent （BMS） or drug-eluting stent （DES） in Chinese Han ethnic population. Mothods A total of 1633 consecutive patients with CAD who had undergone coronary stenting, quantitative coronary angiography （QCA） were retrospectively studied. At the time of stent implantation and at 7 months post-stenting 675 patients had a follow-up angiography. Statistical analysis was made with the chi-square test for categorical variables, unpaired t test for continuous variables, univariate or multivariate regression for baseline and angiographic characteristics and the Kaplan-Meier method for rate of target lesion revascularization （TLR）. Results Stent restenosis was defined as ≥50% diameter stenosis in the dilated segment. A total of 675 patients with 1074 lesions were subjected to angiographic follow-up for 7 months on average, Of these lesions, 448 were implanted with BMS whereas 626 lesions with DES. At 7 months, bare-metal in-stent restenosis occured in 148 lesions （33.0%）, and bare metal in-segment restenosis in 155 lesions （34.6%） in contrast to drug-eluting in-stent restenosis in 48 lesions （7.7%） and drug-eluting in-segment restenosis in 73 lesions （11.7%） （P〈0.001 compared with BMS respectively）. Late loss in both in-stent and in segment was higher in BMS than in DES groups [（1.00±0.69） vs （0.28±0.52）; （0.78±0.71） vs （0.21±0.52）, P〈0.001 respectively]. Angulated lesion, lesion length, pre-procedural minimal luminal diameter （MLD）, and BMS were independent predictors for TLR, （P〈0.01 respectively）, whereas current smoker, ostial lesion, and stent overlapping, post-procedure in-stent MLD, lesion length, and stent types were independent predictors for in-segment restenosis （P〈0.01 respectively）. Standard coronary risk factors such as hypertension, hyperlipidemia, diabetes, and history of CAD were not associated with a higher rate of restenosis caused by BMS or DES implantation in our Chinese Hart ethnic population. Conclusions Coronary stenting including BMS or DES implantation in Chinese Han ethnic patients is associated with a restenosis rate comparable to that demonstrated in previous studies from the western countries, and predictors of stent restenosis are somehow different from those in the western population.

One-year clinical outcomes of Chinese sirolimus-eluting stent in the treatment of unselected patients with coronary artery disease

The application of drug-eluting stent （DES）, either sirolimus-eluting stent （Cypher, Cordis, USA） or paclitaxel-eluting stent （Taxus, Boston Scientific, USA）, in treatment of patients with coronary artery disease （CAD） has achieved great success. The high cost of imported DES （either Cypher or Taxus） gave the birth to a China-made, polymer-based, sirolimus-eluting stent （Firebird, Microport Company,

《药物涂层球囊临床应用中国专家共识(第二版)》解读

《中国介入心脏病学杂志》2023年6月发表了《药物涂层球囊临床应用中国专家共识(第二版)》,共识结合近年来药物涂层球囊在冠心病介入治疗领域的循证医学证据,对药物涂层球囊的适应证、规范操作、腔内影像和冠状动脉功能学在药物涂层球囊治疗中的应用等进行了更新。本文结合临床诊疗实践和循证医学证据,就该共识亮点进行解读,以期为临床实践提供参考。

桡动脉入路冠状动脉造影+支架植入术治疗老年冠状动脉粥样硬化性心脏病患者疗效及安全性研究

研究分析老年冠状动脉粥样硬化性心脏病患者采用桡动脉入路冠状动脉造影+支架植入术治疗的效果及安全性。选取2021年1月—2022年1月接受治疗的60例老年冠状动脉粥样硬化性心脏病患者为研究对象,按照随机数字表法将患者分为常规组和实验组,每组30例。予以常规组患者股动脉入路冠状动脉造影+支架植入术,予以实验组患者桡动脉入路冠状动脉造影+支架植入术,比较两组患者疗效及安全性。结果显示,实验组患者手术指标、术后恢复相关指标均优于常规组(P<0.05);实验组患者术后并发症发生率低于常规组(P<0.05);实验组患者术后心功能恢复情况优于常规组(P<0.05);实验组患者心肌微循环指标优于常规组(P<0.05);实验组患者血管内皮功能优于常规组(P<0.05)。研究发现,桡动脉入路冠状动脉造影+支架植入术治疗老年冠状动脉粥样硬化性心脏病患者效果较好,患者手术安全性较高,可促进患者术后心功能恢复,减小手术对于患者血管内皮功能的影响。

Drug-eluting stent for the treatment of small coronary lesion:comparison between sirolimus- and paclitaxel-eluting stent

Background Patients with small coronary lesions are at increased risk for repeat interventions after coronary angioplasty and stenting. The efficacy of drug-eluting stents （DES） has been demonstrated to improve the outcomes of these patients and is a focus of interest. Currently, two platforms of DES are available （sirolimus-eluting stent （SES） and paclitaxel-eluting stent （PES））. However, it has less been known that DES, SES vs PES, is superior for the treatment of small coronary lesions. Methods In this retrospective study, 87 consecutive patients with 151 lesions underwent implantation of coronary SES （n=68） and PES （n=83）. Quantitative coronary angiography （QCA） was performed at the time of stent implantation and subsequently at 8 months post-stenting. Small vessel disease was defined as lesions in vessels with diameter 42.5 mm measured by QCA. Major adverse cardiac events （MACE） including death, thrombosis, nonfatal myocardial infarction and target lesion revascularization （TLR） were compared between the two groups. Results Baseline clinical characteristics and angiographic parameters were similar between the two groups. At clinical and angiographic follow-up, overall thrombosis rates were similar in both groups （0 vs 1.2%, P〉0.05）. The TLR and in-segment restenosis were not significantly different （19.1% vs 25.3%; 10.3% vs 10.8%, P=0.365 and P=0.913 respectively） between the two groups. The in-stent restenosis rate, however, was significantly higher in the PES group （4.4% vs 21.7%; P=0.002）. Similarly, the late loss was significantly higher in the PES group （（0.14±0.38） mm vs （0.49±0.61） mm; P〈0.001）. Conclusions In this small sample-size, non-randomized study, the data indicated that implantation of SES for the treatment of patients with small coronary lesion showed more favorable results in respect of restenosis compared with PES implantation.

A comparison of angiographic and clinical outcomes after sirolimus-eluting versus paclitaxel-eluting stents for the treatment of in-stent restenosis

Background In-stent restenosis （ISR） remains a challenge for interventional cardiologists. Some data suggest that drug-eluting stents （DES） represent a promising new option for the treatment of patients with ISR. Currently, 2 DES platforms are available [sirolimus-eluting stents （SES） and paclitaxel-eluting stents （PES） ], but the superiority of either approach for treating ISR has not been convincingly demonstrated. The aim of the present study was to retrospectively compare angiographic and clinical outcomes after treatment of ISR with SES or PES in a series of consecutive patients with ISR.

Predictive Ability of the SYNergy Between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery Score Ⅱ for Long-term Mortality in Patients with Three-vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention Treated

Background：The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score Ⅱ （SS-Ⅱ） can well predict 4-year mortality in patients with complex coronary artery disease （CAD）,and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention （PCI）.However,there is lack of data regarding the utility of the SS-Ⅱ in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents （DES）.The purpose of the present study was to evaluate the ability of the SS-Ⅱ to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES.Methods：Totally,573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied.According to the tertiles of the SS-Ⅱ,the patients were divided into three groups：The lowest SS-Ⅱ tertile （SS-Ⅱ ≤20）,intermediate SS-Ⅱ tertile （SS-Ⅱ of 21-31）,and the highest SS-Ⅱ tertile （SS-Ⅱ ≥32）.The survival curves of the different groups were estimated by the Kaplan-Meier method.Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-Ⅱ and 5-year mortality.The performance of the SS-Ⅱ with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic （ROC） curve.The predictive ability of the SS-Ⅱ for 5-year mortality was evaluated and compared with the SS alone.Results：The overall SS-Ⅱ was 27.6 ± 9.0.Among patients in the lowest,intermediate and the highest SS-Ⅱ tertiles,the 5-year rates of mortality were 1.6%,3.2%,and 8.6%,respectively （P =0.003）;the cardiac mortality rates were 0.5%,1.9%,and 5.2%,respectively （P =0.014）.By multivariable analysis,adjusting for the potential confounders,the SS-Ⅱ was an independent predictor of 5-year mortality （hazard ratio：2.45,95% confidence interval：1.38-4.36;P=0.002）.The SS-Ⅱ demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone （the area under the ROC curve was 0.705 and 0.598,respectively）.Conclusion：The SS-Ⅱ is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES,and demonstrates a superior predictive ability over the SS alone.