Evaluation of Clinical Outcomes of ses Stent in Patients with Coronary Artery Disease After Intracoronary Stenting in Small Vessels

Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

Acute kidney injury following percutaneous coronary intervention （PCI） is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury （AKI） in patients after intracoronary stent implantation are still unknown. A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included： 1） pre-operative ones： age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate （eGFR）, hyperuricemia, proteinuria, emergency operation, hydration, medications （ACEI/ARBs, statins）; 2） intraoperative ones： dose of contrast media, operative time, hypotension; and 3） postoperative one： hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis. Of the 325 patients, 51（15.7%） developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters （left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration）, emergency operation, intraoperative parameters （operative time, hypotension） and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age （OR=0.253, 95%CI=0.088-0.727）, pre-operative proteinuria （OR=5.351, 95%CI=2.128-13.459）, pre-operative left ventricular insufficiency （OR=8.704, 95%CI=3.170-23.898）, eGFR〈60 ml/min/1.73 m2 （OR=6.677, 95%CI=1.167-38.193）, prolonged operative time, intraoperative hypotension （OR=25.245, 95%CI=1.001-1.034） were independent risk factors ofAKl. AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors ofAKl.

Intracoronary stent implantation under intracoronary ultrasound guidance with aspirin and ticlopidine therapy

Objective To observe the immediate angiographic and intravascular ultrasound (IVUS) results and their effects on one month clinical outcomes in forty one patients who submitted to coronary stent deployment with IVUS guidance Methods All patients were allocated to coronary stent implantation with high inflation pressure After good angiographic results (<20% residual stenosis), all patients underwent IVUS and higher pressure dilatation would be necessary if criteria for optimal coronary stent implantation were not met The optimal criterion of IVUS for stent implantation was the ratio of intrastent lumen cross sectional area to the average of the proximal and distal reference lumen cross sectional areas ≥80% All patients had aspirin and ticlopidine therapy on the day of angioplasty and during the one month follow up period Results Optimal criteria of IVUS were obtained without any further intrastent dilatation in twenty five patients but intrastent higher pressure dilatation was performed in fourteen patients whose ultrasound results did not reach the criteria In these patients, we increased the minimal intrastent lumen area 25 7% ( P <0 05) Thirty five patients (90%) had good minimal intrastent lumen area of IVUS There were no deaths, myocardial infarction, acute stent thrombosis or need for revascularization during the study and the one month follow up Conclusions Intracoronary stent deployment under IVUS guidance, including combining aspirin and ticlopidine therapy, had beneficial ultrasound results and good clinical outcomes after one month follow up

Effects of Erigeron Injection on Vascular Endothelium in Patients after Intracoronary Stenting

Objective： To observe the levels of serum C-reactive protein （CRP）, endothelin-1 （ET-1）, nitric oxide （NO）, and superoxide dismutase （SOD） in patients after intracoronary stenting （ICS）, and the effects of Erigeron Injection （E1） on them. Methods： Seventy-two patients, who received ICS and had symptoms of chest stuffiness, palpitation and chest pain, were randomly divided into two groups, with 36 patients in the control group treated with Plavix alone for anti-platelet aggregation, and the other 36 patients in the treated group treated with Plavix and El in combination. CRP, ET-1, NO and SOD were determined and compared before and 1, 2 and 3 weeks after treatment. Results： As compared with those in the control group, improvement of symptoms in the treated group was significantly better, with the levels of CRP and ET-1 lower and levels of SOD and NO higher or approaching to normal ranges and significant difference was shown between the two groups （P〈0.01）. Conclusion： El could alleviate uncomfortable feelings such as chest stuffiness in patients after lOS, and improve the function of vascular endothelium.

Diagnostic value of magnetocardiography in patients with coronary heart disease and in-stent restenosis

Background In-stent restenosis （ISR） has become one of the most challenging problems in patients with coronary heart disease. At present, using non-invasive methods to assess ISR is a hot topic. In this investigation we attempted to explore the potential of magnetocardiography （MCG） in diagnosis of in-stent restenosis. Methods MCG was analyzed in 52 patients with coronary artery disease for three times： before stenting, one month and 7 months after successful intracoronary stenting. Results The average classification of total maps （ACTM） and the ratio of abnormal maps （RAM） were lower in 1 month after intracoronary stenting compared with that obtained before stent planting （2.91 vs 2.52, 65.74% vs 42.80%, P〈0.01）, while complex ventricular excitation index （CVEI） increased from -42.63 to -20.05 （P〈0.01）. In ISR subgroup （n=16）, RAM decreased in 1 month after intracoronary stenting compared to it before stenting （68.99% vs 45.26%, P〈0.05）. ACTM increased in 7 months compared to that obtained in 1 month after stenting （3.15 vs 2.51, P〈0.05）. According to the ROC curve, ACTM showed its unique diagnostic value in restenosis patients. The sensitivity and specificity of ACTM were 80.0%, 69.40%, respectively. Its positive predictive value and negative predictive value were 54.6% and 88.5%, respectively. Conclusions After successful intracoronary stenting, most parameters of MCG were improved. ACTM was of prognostic value in diagnosing ISR.