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 dru...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.展开更多
The incidence of acute myocardial infarction (AMI) is increasing year by year, which seriously endangers human health around the world. The preferred treatment strategy for AMI patients is the use of drug-eluting sten...The incidence of acute myocardial infarction (AMI) is increasing year by year, which seriously endangers human health around the world. The preferred treatment strategy for AMI patients is the use of drug-eluting stents (DES), as there is ample evidence to suggest that stent implantation can reduce major adverse cardiovascular events (MACEs). With the application of drug-coated balloons (DCBs) and the enhancement of the concept of interventional without implantation, the question is whether DCBs can be safely and effectively used in patients with AMI? The purpose of this study was to investigate the safety and effectiveness of DCBs in the treatment of AMI. A retrospective review of clinical data was conducted on 55 AMI patients who underwent primary percutaneous coronary intervention (PCI) from January 2020 to December 2021. Of these patients, 25 were treated with DCBs and 30 were treated with DESs. Optical coherence tomography (OCT) was used to measure the minimum lumen diameter, lumen stenosis, and coronary artery dissection before and after surgery, and angina pectoris attacks and various MACEs were recorded at 1, 6, and 12 months after surgery. The results showed that there were no significant differences in clinical baseline data between the two groups. However, the minimum lumen diameter of the DCB group immediately after the operation was smaller than that of the DES group, and the stenosis degree of the lumen in the DCB group was higher than that in the DES group. The incidence of coronary artery dissection in the DCB group was significantly higher than that in the DES group, but the majority of them were type B. At 1, 6, and 12 months after treatment, there was no significant difference in the occurrence of MACEs between the two groups. In conclusion, DCBs is a safe and effective treatment for AMI. However, the incidence of coronary artery dissection in DCB patients is higher than that in DES patients, but the majority of them are type B. .展开更多
Compared with bare-metal stents (BMS),drug-eluting stems (DES)have shown better clinical outcomes for pa- tients undergoing percutaneous coronary intervention (PCI) by inhibition of neo-intirnal hyperplasia.[1]However...Compared with bare-metal stents (BMS),drug-eluting stems (DES)have shown better clinical outcomes for pa- tients undergoing percutaneous coronary intervention (PCI) by inhibition of neo-intirnal hyperplasia.[1]However,early- generation DES produced late thrombotic events,more than l-year,by delaying arterial healing of stented vessels,[2-5] New-generation DES have been developed'with thinner stent struts,more biocompatible polymer coatings for drug release,and a variety of antiproliferative agents with similar or superior anti-restenotic efficacy.[6]This development has led to a significant improvement in the efficacy and safety of new-generation DES,and consistently lower rates of very late stent thrombosis (VLST).[7,8]In fact,use of new-ge- neration DES is the standard treatment in contemporary PCI practice.[9]展开更多
BACKGROUND Myocardial bridging(MB)is increasingly recognized to stimulate atherogenesis,which may contribute to an acute coronary syndrome.Stenting the coronary segment with MB has been recognized to have an increased...BACKGROUND Myocardial bridging(MB)is increasingly recognized to stimulate atherogenesis,which may contribute to an acute coronary syndrome.Stenting the coronary segment with MB has been recognized to have an increased risk of in-stent restenosis,stent fracture and coronary perforation.The safety and efficacy of stenting the culprit lesion with overlaying MB in ST elevation myocardial infarction(STEMI)as primary reperfusion therapy has not been established.CASE SUMMARY We reported a patient who presented with inferior STEMI with a culprit lesion of an acute thrombotic occlusion in the right coronary artery and thrombolysis and thrombin inhibition in myocardial infarction 0 flow.After the stent placement during primary percutaneous coronary intervention,intravascular ultrasound revealed MB overlying the stented segment where heavy atherosclerotic plaque were present.Likely due to the combination of plaque herniation or prolapse caused by MB,as well as local increased inflammation and thrombogenicity,acute stent thrombosis occurred at this region,which led to acute stent failure.The patient required an emergent repeated cardiac catheterization and placing a second layer of stent to enhance the radial strength and reduce the inter-strut space.CONCLUSION Plaque herniation or prolapse after stenting a MB segment in STEMI is a potential etiology for acute stent failure.展开更多
Background: The ST-segment elevation myocardial inthrction (STEMI) patients due to stent thrombosis (ST) remain a therapeutic challenge for a clinician. Till date, very few researches have been conducted regardin...Background: The ST-segment elevation myocardial inthrction (STEMI) patients due to stent thrombosis (ST) remain a therapeutic challenge for a clinician. Till date, very few researches have been conducted regarding the safety and effectiveness of primary percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) for STEMI caused by very late ST (VLST). This retrospective study evaluated the safety, efficacy, and outcomes of primary PCI with second-generation DES for STEM1 due to VLST compared with primary PCI for STEM1 due to de novo lesion. Methods: Between January 2007 and December 2013, STEMI patients with primary PCI in Fuwai Hospital had only second-generation DES implanted for de novo lesion (558 patients) and VLST (50 patients) were included in this retrospective study. The primary end points included cardiac death and reinfarction. The secondary end points included cardiac death, reinfarction, and target lesion revascularization. Continuous variables were expressed as mean (standard deviation) or median (interquartile range) and compared by Student's t-test or Mann-Whitney U-test as appropriate. Categorical variables were expressed as counts and percentages, and comparison of these variables was performed with Chi-square or Fisher's exact test. A two-tailed value of P 〈 0.05 was considered statistically significant for all comparisons. Statistical analyses were performed by SAS software (version 9.4, SAS Institute Inc., Cary, USA) for Windows. Results: In-hospital primary end point and the secondary end point were no significant differences between two groups (P = 1.000 and P = 1.000, respectively). No significant differences between two groups were observed according to the long-term primary end point and the secondary end point. Kaplan-Meier survival curves showed no significant difference between the two groups in the primary end point and the secondary end point at 2 years (P- 0.340 and P = 0,243, respectively). According to Cox analysis, female, intra-aortic balloon pump support, and postprocedural thrombolysis in myocardial infarction flow 3 were found to be independent predictors fbr long-term follow-up. Conclusion: Primary PCI with second-generation DES is a reasonable choice for STEMI patients caused by VLST.展开更多
Although the incidence of coronary stent fracture (SF) is relatively rare, the increasing amount of patients v undergoing percutaneous indicates more cases coronary- intervention (PCI) of SF. The incidence of sir...Although the incidence of coronary stent fracture (SF) is relatively rare, the increasing amount of patients v undergoing percutaneous indicates more cases coronary- intervention (PCI) of SF. The incidence of sirolimus-eluting stent (SES) fracture is reported in 0.89% to 4.4% of patients at 6 to 12 months follow-up 12 anglography post-PCI. Recently, SF has been recognized as a complication that may result in thrombosis, perforation, restenosis, and migration of the stent resulting in morbidity and mortality. Here we describe a rare case presented with ST-elevation myocardial infarction (STEMI), which was caused by very late stent thrombosis due to SES fracture, in order to help the physicians ensure rapid recognition and treatment of this urgent situation.展开更多
Kounis syndrome is the concurrence of coronary spasm, acute myocardial infarction or stent thrombosis, with allergic reactions in the setting of mast-cell and platelet activation. In this report Kounis syndrome manife...Kounis syndrome is the concurrence of coronary spasm, acute myocardial infarction or stent thrombosis, with allergic reactions in the setting of mast-cell and platelet activation. In this report Kounis syndrome manifesting as stent thrombosis with left ventricular thrombus formation was triggered by a food-induced allergic reaction. The allergic reaction to food was confirmed by oral rice pudding ingredients challenge test while skin tests were inconclusive. To our knowledge, this is first report of early stent thrombosis secondary to food allergic reaction in a 70-year-old man patient who was found to have left ventricular thrombus and undiagnosed hypertrophic cardiomyopathy.展开更多
Recent analyses have suggested that implantation of drug-eluting stents (DES) is associated with a higher rate of very late stent thrombosis when compared with bare metal stents (BMS). According to Academic Resear...Recent analyses have suggested that implantation of drug-eluting stents (DES) is associated with a higher rate of very late stent thrombosis when compared with bare metal stents (BMS). According to Academic Research Consortium (ARC) definition,1 very late stent thrombosis refers to events occurring more than 12 months following stent placement. This complication is evident with sirolimus-eluting stents (SES) as well as polymer-based paclitaxel-eluting stents (PES),展开更多
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 pati...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.展开更多
Background Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in ...Background Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI. Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission (RD group), and the remaining 533 patients had normal renal function (non-RD group). The primary endpoint was 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization), and the secondary endpoint was subacute stent thrombosis. Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 (29.1% vs 18.6%, P=0.02) and multi-vessel (62.8% vs 44.5%, P=0.001) and triple vessel disease (32.6% vs 18.2%, P=0.002), in-hospital mortality (9.3% vs 3.8%, P=0.03), and MACE rate during hospitalization (17.4% vs 7.7%, P=-0.006) were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%, P=-0.0003). Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group, respectively (P=0.15). Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31,95% CI 1.19-9.18, P 〈0.001). Conclusion Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.展开更多
Background The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) und...Background The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation. Methods A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n=83) or BMS (n=108) implantation in the infarction related artery according to physician's discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups. Results The clinical follow-up duration was 3 years ((41.7±16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P=0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P=0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P=-0.379) and stent thrombosis (1.20% vs. 1.85%, P=0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P=0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P=0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n=73) and paclitaxel-eluting stents (PES, n=10) subgroups (2.74% vs. 20.00%, P 〉0.05). Conclusions This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.展开更多
Background Since permanent polymer is implicated in adverse events associated with delayed vessel healing after drug eluting stents (DES) implantation, great efforts have been made to develop more biocompatible DES ...Background Since permanent polymer is implicated in adverse events associated with delayed vessel healing after drug eluting stents (DES) implantation, great efforts have been made to develop more biocompatible DES with biodegradable polymer or without polymer. The present study aimed to evaluate the safety and efficacy of polymer free paclitaxel-eluting stents (PF-PES) in comparison with permanent polymer sirolimus-eluting stents (PP-SES) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Patients with STEMI were randomly assigned to receive PP-SES (n=55), and PF-PES (n=50). The 6-month angiographic and 1-year clinical outcomes were compared between the two groups. Target lesion failure (TLF) was defined as the composite of cardiac death, recurrent nonfatal myocardial infarction (Re-MI), or target lesion revascularization (TLR). Results Follow-up angiography at six months was performed in 72.7% of the PP-SES group and 70.0% of the PF-PES group (P=0.757). The two groups had comparable angiographic outcomes including minimal luminal diameter, diameter stenosis, late loss and binary restenosis. All patients were clinically followed up to one year. The two groups had similar clinical outcomes with relatively low rates of target lesion failure (10.9% PP-SES vs. 12.0% PF-PES, P=0.861) and definite or probable stent thrombosis (1.8% PP-SES vs. 2.0% PF-PES, P=1.000) at one year. Conclusions The present study suggests that the safety and efficacy of PF-PES in the setting of STEMI are comparable to PP-SES. Further randomized trials with laraer study DODUlations are needed to net definite conclusions.展开更多
Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-t...Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P=-0.03) and had longer time delay from symptom onset to admission ((364±219) minutes and (309±223) minutes, P=-0.02) than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P〈0.001). Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG) 〉2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P=-0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P=-0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P=-0.03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P=0.02). Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P=0.19). All of these patients experienced non-fatal myocardial infarction. Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.展开更多
70-year-old female with no Aprevious cardiac history resented with complaints of severe chest and back pain lasting for 20 minutes. She had a past history of type 2 diabetes mellitus for five years and hypertension fo...70-year-old female with no Aprevious cardiac history resented with complaints of severe chest and back pain lasting for 20 minutes. She had a past history of type 2 diabetes mellitus for five years and hypertension for twenty years, but denied a history of hyperlipidemia, smoking or hemorrhagic disorder. There was no family history of coronary artery or hematologic disease. On physical examination, the blood pressure was 145/90 mmHg and the heart rate was 102 beats/rain. Cardiac examination revealed normal S1 and $2 sounds. There were no murmors or clicks. The lungs were clear on auscultation. Hepatosplenomegaly or lymphadenopathy was not detected. Her electrocardiogram showed ST elevations in lead V1-V6, consistent with acute anterior MI and echocardiogram supported the diagnosis with a slight reduction in wall motion in the anterior region. Complete blood count revealed a white blood cell count of 9 000/mm3 with a normal differential, red blood cell count of 3.5×106/mm3, hematocrit of 40.2%, and platelet count of 238 000/mm3. Emergent coronary angiography demonstrated proximal thrombotic occlusion of the left anterior descending artery (LAD) (Figure 1A). A loading dose of 600 mg clopidogrel and 300 mg acetylsalicylic asid (ASA) was given immediately. After administration of 10 000 U intravenous heparin, angioplasty was performed and a 3.0 mm×20.0 mm bare metal stent (BMS) was deployed to the LAD. Repeat angiogram revealed TIMI III flow in the LAD (Figure 1B). Five days later, the patient was discharged without any bleeding or thrombotic complications. She was receiving dual antiplatelet therapy with ASA and clopidogrel 150 mg daily. However, she was admitted to our hospital again with severe chest pain just one day after dischargement. Her platelet count of 487 000/mm3 was remarkable in comparison with her previous complete blood count. Electrocardiogram showed ST elevations in leads V1-V6, suggestive of an acute anterior reinfarction. Coronary angiography revealed in- stent thrombosis in the LAD (Figure 1C). After balloon angioplasty (Figure 1D), TIMI III flow was achieved and no residual stenosis was seen. During her follow-up, complete blood cell counts showed gradually increasing platelets up to 818 000/ram3, on the fourth day of sub- acute stent thrombosis. Peripheral blood smear examination was performed and showed markedly increased large thrombocytes with anisothrombia, consistent with essential thrombocythemia (ET). Soon after, platelet-loweringtherapy with hydroxyurea (500 mg/d) was initiated, One week after the initiation of hydroxyurea, the platelet count was decreased to 220 000/ram3. The patient remained on hydroxyurea and dual antiplatelet therapy. She was free of symptoms for three months during the follow-up period and her platelet counts remained within the normal range.展开更多
Background The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies. However, this has not been thoroughly evaluated in ST elevation myocardial i...Background The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies. However, this has not been thoroughly evaluated in ST elevation myocardial infarction. Methods This was a prospective, randomized, controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction, treated with zotarolimus-eluting stents or sirolimus-eluting stents. From March 2007 to February 2009, 122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion. The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography, and secondary endpoints were percent diameter stenosis, binary restenosis rate, major adverse cardiac events (a composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization), and late-acquired incomplete stent apposition. Results Angiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49±0.65) mm vs. (0.10±0.46) mm, P=0.001). Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0±17.9)% vs. (17.6±14.0)%, P 〈0.001). In-segment analysis showed similar findings. There were no significant differences in binary restenosis rate, major adverse cardiac events, and late-acquired incomplete stent apposition. Conclusions Compared to sirolimus-eluting stents, the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction. Although there was no significant difference in 1-year clinical outcomes, the clinical implication of increased late lumen loss should be further studied.展开更多
Background The benefits and safety of sirolimus-eluting stent (SES) have not been systematically quantified in different trials in ST-segment elevation myocardial infarction (STEMI) patients with primary or rescue...Background The benefits and safety of sirolimus-eluting stent (SES) have not been systematically quantified in different trials in ST-segment elevation myocardial infarction (STEMI) patients with primary or rescue percutaneous coronary intervention (PCI). A meta-analysis of randomised trials comparing SES and bare-metal stent (BMS) was performed. Methods A systematic literature search was conducted to identify all randomized clinical trials. The primary outcome was the rate of major adverse cardiac events (MACEs). The secondary outcomes included death, recurrent myocardial infarction, recurrent revascularization, and stent thrombosis.Results Totally, 1973 STEMI patients were enrolled in seven eligible randomized trials comparing SES with BMS. The pooled rate of major adverse cardiac events was significantly lower in the SES group than in the BMS group (9.7% vs 20.3%, OR 2.45, 95% Cl 1.88-3.19, P 〈 0.00001). No significant difference in all causes of death was found between the SES and BMS groups, as well as in the pooled recurrent myocardial infarction rates. The pooled recurrent revascularization rate was significantly lower in the SES group than in the BMS group (5.1% vs 14.8%, OR 3.30, 95%CI 2.37-4.60, P 〈 0.00001). No significant difference was found between the pooled rates of stent thrombosis (1.2% in the SES group and 2.0% in the BMS group, OR 1.61, 95%CI 0.79-3.26, P = 0.19).Conclusions SES is associated with a decreased risk of major adverse cardiac events compared with BMS by the greater reduction in repeat revascularization in STEMI patients. Larger trials with longer follow up are warranted to better define the role of SES in STEMI.展开更多
Acute total or subtotal occlusion of left main coronary artery (LMCA) is a catastrophic and mostly fatal event. Patients may present with cardiogenic shock and die whenever this event occurs. Survival is strongly depe...Acute total or subtotal occlusion of left main coronary artery (LMCA) is a catastrophic and mostly fatal event. Patients may present with cardiogenic shock and die whenever this event occurs. Survival is strongly dependent on the presence of collateral blood flow to the left coronary artery or a dominant right coronary artery, and emergency intervention for preserving the left ventricular function. Here, we present a case of a 14-year-old boy with subtotal occlusion of the LMCA accompanying acute myocardial infarction probably caused by congenital syphilis according to his positive serum syphilis antibody. His survival was closely associated with a dominant right coronary artery and timely thrombolytic therapy. Finally, he was treated with angioplasty and paclitaxel-eluting stent implantation. He was followed up after stenting and was doing quite well at the time when we wrote this paper.展开更多
Background: Vaccines remain the only viable and safe option to control transmission and minimise disease sequelae during the COVID-19 pandemic. Whilst multiple vaccines are available, evidence has emerged regarding th...Background: Vaccines remain the only viable and safe option to control transmission and minimise disease sequelae during the COVID-19 pandemic. Whilst multiple vaccines are available, evidence has emerged regarding the association between the ChAdOx1 nCoV-19 vaccine, platelets and thrombosis, manifesting in thrombotic thrombocytopaenia. Case Summary: We report a case of recurrent coronary artery thrombosis on triple antithrombotic therapy, namely aspirin, clopidogrel, and continuous intravenous heparin, nine days after the ChAdOx1 nCoV-19 vaccine, in a 63-year-old female with no significant history of cardiovascular disease. Conclusion: This case may suggest that the association between platelets, SARS-CoV-2, the ChAdOx1 nCoV-19 vaccine, and coronary thrombosis may remain incompletely understood and warrants further study. Clinicians should remain on high alert if presented with similar circumstances.展开更多
Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass graftin...Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass grafting (CABG) surgeries may protect the patient against ischemic complications due to acute stent occlusion. This issue, however, is controversial. Loss of bypass graft function may occur in the early stages due to the competition between native flow and graft flow. In the present study, the effects of bypass surgery to an artery with a patent stent on the outcomes were investigated. Methods: Fifty nine patients who had undergone isolated CABG surgery within 6 weeks after a successful primary PTCA/stent placement were included in the study. Patients who had undergone emergency operation due to suspicion of acute stent occlusion and the redo cases were excluded in the study. Patients were divided into two groups;those with (Group P, protected) and without (Group NP;non-protected) coronary bypass to an artery with a patent stent. Preoperative, operative and postoperative data were collected retrospectively from the patient files. The need for urgent revascularization was recorded postoperatively. Mann-Whitney U test was used for the analysis of continuous variables, whereas categorical variables were analyzed either using Pearson's chisquare test or Fisher's exact test. Results: Of 59 patients, 35 underwent bypass surgery to the artery with patent stent, whereas bypass was not performed on 24 patients. It was observed that dual antiplatelet therapy had been performed on 20% of the patients in Group P and 87.5% of those in Group NP (p = 0.001). No acute ischemic change due to stent occlusion was determined in Group P, whereas it was observed in one patient in Group NP (p = 0.4). The prevalence of hospital mortality was found to be 8.6% and 8.3% in Group P and Group NP, respectively (p = 1). Conclusions: Although it was not statistically significant, it was observed that bypass surgery might have a protective effect against stent occlusion in patients who underwent bypass surgery. However, postoperative dual antiplatelet therapy substantially prevented stent occlusion in those without bypass surgery. On the other hand, stent-supported coronary circulation may be unsafe in case of discontinuation of clopidogrel therapy. Therefore, it was suggested that performing bypass surgery to an artery with a patent stent would be more reasonable in patients who underwent semi-urgent CABG surgery.展开更多
Coronary stent fracture (SF) is a rare but potentially serious complication of coronary arterystenting. Here we report a case of acute myocardial infarction as a consequence of very late in-stent thrombosis due to m...Coronary stent fracture (SF) is a rare but potentially serious complication of coronary arterystenting. Here we report a case of acute myocardial infarction as a consequence of very late in-stent thrombosis due to multiple stent fractures at 8 sites and multiple stent malapposition formation four years after a sirolimus-eluting stent implantation (Firebird, Microport, Shanghai, China).展开更多
文摘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.
文摘The incidence of acute myocardial infarction (AMI) is increasing year by year, which seriously endangers human health around the world. The preferred treatment strategy for AMI patients is the use of drug-eluting stents (DES), as there is ample evidence to suggest that stent implantation can reduce major adverse cardiovascular events (MACEs). With the application of drug-coated balloons (DCBs) and the enhancement of the concept of interventional without implantation, the question is whether DCBs can be safely and effectively used in patients with AMI? The purpose of this study was to investigate the safety and effectiveness of DCBs in the treatment of AMI. A retrospective review of clinical data was conducted on 55 AMI patients who underwent primary percutaneous coronary intervention (PCI) from January 2020 to December 2021. Of these patients, 25 were treated with DCBs and 30 were treated with DESs. Optical coherence tomography (OCT) was used to measure the minimum lumen diameter, lumen stenosis, and coronary artery dissection before and after surgery, and angina pectoris attacks and various MACEs were recorded at 1, 6, and 12 months after surgery. The results showed that there were no significant differences in clinical baseline data between the two groups. However, the minimum lumen diameter of the DCB group immediately after the operation was smaller than that of the DES group, and the stenosis degree of the lumen in the DCB group was higher than that in the DES group. The incidence of coronary artery dissection in the DCB group was significantly higher than that in the DES group, but the majority of them were type B. At 1, 6, and 12 months after treatment, there was no significant difference in the occurrence of MACEs between the two groups. In conclusion, DCBs is a safe and effective treatment for AMI. However, the incidence of coronary artery dissection in DCB patients is higher than that in DES patients, but the majority of them are type B. .
文摘Compared with bare-metal stents (BMS),drug-eluting stems (DES)have shown better clinical outcomes for pa- tients undergoing percutaneous coronary intervention (PCI) by inhibition of neo-intirnal hyperplasia.[1]However,early- generation DES produced late thrombotic events,more than l-year,by delaying arterial healing of stented vessels,[2-5] New-generation DES have been developed'with thinner stent struts,more biocompatible polymer coatings for drug release,and a variety of antiproliferative agents with similar or superior anti-restenotic efficacy.[6]This development has led to a significant improvement in the efficacy and safety of new-generation DES,and consistently lower rates of very late stent thrombosis (VLST).[7,8]In fact,use of new-ge- neration DES is the standard treatment in contemporary PCI practice.[9]
文摘BACKGROUND Myocardial bridging(MB)is increasingly recognized to stimulate atherogenesis,which may contribute to an acute coronary syndrome.Stenting the coronary segment with MB has been recognized to have an increased risk of in-stent restenosis,stent fracture and coronary perforation.The safety and efficacy of stenting the culprit lesion with overlaying MB in ST elevation myocardial infarction(STEMI)as primary reperfusion therapy has not been established.CASE SUMMARY We reported a patient who presented with inferior STEMI with a culprit lesion of an acute thrombotic occlusion in the right coronary artery and thrombolysis and thrombin inhibition in myocardial infarction 0 flow.After the stent placement during primary percutaneous coronary intervention,intravascular ultrasound revealed MB overlying the stented segment where heavy atherosclerotic plaque were present.Likely due to the combination of plaque herniation or prolapse caused by MB,as well as local increased inflammation and thrombogenicity,acute stent thrombosis occurred at this region,which led to acute stent failure.The patient required an emergent repeated cardiac catheterization and placing a second layer of stent to enhance the radial strength and reduce the inter-strut space.CONCLUSION Plaque herniation or prolapse after stenting a MB segment in STEMI is a potential etiology for acute stent failure.
文摘Background: The ST-segment elevation myocardial inthrction (STEMI) patients due to stent thrombosis (ST) remain a therapeutic challenge for a clinician. Till date, very few researches have been conducted regarding the safety and effectiveness of primary percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) for STEMI caused by very late ST (VLST). This retrospective study evaluated the safety, efficacy, and outcomes of primary PCI with second-generation DES for STEM1 due to VLST compared with primary PCI for STEM1 due to de novo lesion. Methods: Between January 2007 and December 2013, STEMI patients with primary PCI in Fuwai Hospital had only second-generation DES implanted for de novo lesion (558 patients) and VLST (50 patients) were included in this retrospective study. The primary end points included cardiac death and reinfarction. The secondary end points included cardiac death, reinfarction, and target lesion revascularization. Continuous variables were expressed as mean (standard deviation) or median (interquartile range) and compared by Student's t-test or Mann-Whitney U-test as appropriate. Categorical variables were expressed as counts and percentages, and comparison of these variables was performed with Chi-square or Fisher's exact test. A two-tailed value of P 〈 0.05 was considered statistically significant for all comparisons. Statistical analyses were performed by SAS software (version 9.4, SAS Institute Inc., Cary, USA) for Windows. Results: In-hospital primary end point and the secondary end point were no significant differences between two groups (P = 1.000 and P = 1.000, respectively). No significant differences between two groups were observed according to the long-term primary end point and the secondary end point. Kaplan-Meier survival curves showed no significant difference between the two groups in the primary end point and the secondary end point at 2 years (P- 0.340 and P = 0,243, respectively). According to Cox analysis, female, intra-aortic balloon pump support, and postprocedural thrombolysis in myocardial infarction flow 3 were found to be independent predictors fbr long-term follow-up. Conclusion: Primary PCI with second-generation DES is a reasonable choice for STEMI patients caused by VLST.
文摘Although the incidence of coronary stent fracture (SF) is relatively rare, the increasing amount of patients v undergoing percutaneous indicates more cases coronary- intervention (PCI) of SF. The incidence of sirolimus-eluting stent (SES) fracture is reported in 0.89% to 4.4% of patients at 6 to 12 months follow-up 12 anglography post-PCI. Recently, SF has been recognized as a complication that may result in thrombosis, perforation, restenosis, and migration of the stent resulting in morbidity and mortality. Here we describe a rare case presented with ST-elevation myocardial infarction (STEMI), which was caused by very late stent thrombosis due to SES fracture, in order to help the physicians ensure rapid recognition and treatment of this urgent situation.
文摘Kounis syndrome is the concurrence of coronary spasm, acute myocardial infarction or stent thrombosis, with allergic reactions in the setting of mast-cell and platelet activation. In this report Kounis syndrome manifesting as stent thrombosis with left ventricular thrombus formation was triggered by a food-induced allergic reaction. The allergic reaction to food was confirmed by oral rice pudding ingredients challenge test while skin tests were inconclusive. To our knowledge, this is first report of early stent thrombosis secondary to food allergic reaction in a 70-year-old man patient who was found to have left ventricular thrombus and undiagnosed hypertrophic cardiomyopathy.
文摘Recent analyses have suggested that implantation of drug-eluting stents (DES) is associated with a higher rate of very late stent thrombosis when compared with bare metal stents (BMS). According to Academic Research Consortium (ARC) definition,1 very late stent thrombosis refers to events occurring more than 12 months following stent placement. This complication is evident with sirolimus-eluting stents (SES) as well as polymer-based paclitaxel-eluting stents (PES),
基金Supported by the Sahajanand Laser Technology Ltd,India
文摘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.
文摘Background Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI. Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission (RD group), and the remaining 533 patients had normal renal function (non-RD group). The primary endpoint was 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization), and the secondary endpoint was subacute stent thrombosis. Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 (29.1% vs 18.6%, P=0.02) and multi-vessel (62.8% vs 44.5%, P=0.001) and triple vessel disease (32.6% vs 18.2%, P=0.002), in-hospital mortality (9.3% vs 3.8%, P=0.03), and MACE rate during hospitalization (17.4% vs 7.7%, P=-0.006) were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%, P=-0.0003). Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group, respectively (P=0.15). Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31,95% CI 1.19-9.18, P 〈0.001). Conclusion Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.
文摘Background The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation. Methods A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n=83) or BMS (n=108) implantation in the infarction related artery according to physician's discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups. Results The clinical follow-up duration was 3 years ((41.7±16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P=0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P=0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P=-0.379) and stent thrombosis (1.20% vs. 1.85%, P=0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P=0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P=0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n=73) and paclitaxel-eluting stents (PES, n=10) subgroups (2.74% vs. 20.00%, P 〉0.05). Conclusions This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.
文摘Background Since permanent polymer is implicated in adverse events associated with delayed vessel healing after drug eluting stents (DES) implantation, great efforts have been made to develop more biocompatible DES with biodegradable polymer or without polymer. The present study aimed to evaluate the safety and efficacy of polymer free paclitaxel-eluting stents (PF-PES) in comparison with permanent polymer sirolimus-eluting stents (PP-SES) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Patients with STEMI were randomly assigned to receive PP-SES (n=55), and PF-PES (n=50). The 6-month angiographic and 1-year clinical outcomes were compared between the two groups. Target lesion failure (TLF) was defined as the composite of cardiac death, recurrent nonfatal myocardial infarction (Re-MI), or target lesion revascularization (TLR). Results Follow-up angiography at six months was performed in 72.7% of the PP-SES group and 70.0% of the PF-PES group (P=0.757). The two groups had comparable angiographic outcomes including minimal luminal diameter, diameter stenosis, late loss and binary restenosis. All patients were clinically followed up to one year. The two groups had similar clinical outcomes with relatively low rates of target lesion failure (10.9% PP-SES vs. 12.0% PF-PES, P=0.861) and definite or probable stent thrombosis (1.8% PP-SES vs. 2.0% PF-PES, P=1.000) at one year. Conclusions The present study suggests that the safety and efficacy of PF-PES in the setting of STEMI are comparable to PP-SES. Further randomized trials with laraer study DODUlations are needed to net definite conclusions.
基金the-grant from Shanghai Science and Technology Foundation(No.05DZ19503)
文摘Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P=-0.03) and had longer time delay from symptom onset to admission ((364±219) minutes and (309±223) minutes, P=-0.02) than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P〈0.001). Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG) 〉2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P=-0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P=-0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P=-0.03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P=0.02). Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P=0.19). All of these patients experienced non-fatal myocardial infarction. Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.
文摘70-year-old female with no Aprevious cardiac history resented with complaints of severe chest and back pain lasting for 20 minutes. She had a past history of type 2 diabetes mellitus for five years and hypertension for twenty years, but denied a history of hyperlipidemia, smoking or hemorrhagic disorder. There was no family history of coronary artery or hematologic disease. On physical examination, the blood pressure was 145/90 mmHg and the heart rate was 102 beats/rain. Cardiac examination revealed normal S1 and $2 sounds. There were no murmors or clicks. The lungs were clear on auscultation. Hepatosplenomegaly or lymphadenopathy was not detected. Her electrocardiogram showed ST elevations in lead V1-V6, consistent with acute anterior MI and echocardiogram supported the diagnosis with a slight reduction in wall motion in the anterior region. Complete blood count revealed a white blood cell count of 9 000/mm3 with a normal differential, red blood cell count of 3.5×106/mm3, hematocrit of 40.2%, and platelet count of 238 000/mm3. Emergent coronary angiography demonstrated proximal thrombotic occlusion of the left anterior descending artery (LAD) (Figure 1A). A loading dose of 600 mg clopidogrel and 300 mg acetylsalicylic asid (ASA) was given immediately. After administration of 10 000 U intravenous heparin, angioplasty was performed and a 3.0 mm×20.0 mm bare metal stent (BMS) was deployed to the LAD. Repeat angiogram revealed TIMI III flow in the LAD (Figure 1B). Five days later, the patient was discharged without any bleeding or thrombotic complications. She was receiving dual antiplatelet therapy with ASA and clopidogrel 150 mg daily. However, she was admitted to our hospital again with severe chest pain just one day after dischargement. Her platelet count of 487 000/mm3 was remarkable in comparison with her previous complete blood count. Electrocardiogram showed ST elevations in leads V1-V6, suggestive of an acute anterior reinfarction. Coronary angiography revealed in- stent thrombosis in the LAD (Figure 1C). After balloon angioplasty (Figure 1D), TIMI III flow was achieved and no residual stenosis was seen. During her follow-up, complete blood cell counts showed gradually increasing platelets up to 818 000/ram3, on the fourth day of sub- acute stent thrombosis. Peripheral blood smear examination was performed and showed markedly increased large thrombocytes with anisothrombia, consistent with essential thrombocythemia (ET). Soon after, platelet-loweringtherapy with hydroxyurea (500 mg/d) was initiated, One week after the initiation of hydroxyurea, the platelet count was decreased to 220 000/ram3. The patient remained on hydroxyurea and dual antiplatelet therapy. She was free of symptoms for three months during the follow-up period and her platelet counts remained within the normal range.
文摘Background The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies. However, this has not been thoroughly evaluated in ST elevation myocardial infarction. Methods This was a prospective, randomized, controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction, treated with zotarolimus-eluting stents or sirolimus-eluting stents. From March 2007 to February 2009, 122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion. The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography, and secondary endpoints were percent diameter stenosis, binary restenosis rate, major adverse cardiac events (a composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization), and late-acquired incomplete stent apposition. Results Angiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49±0.65) mm vs. (0.10±0.46) mm, P=0.001). Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0±17.9)% vs. (17.6±14.0)%, P 〈0.001). In-segment analysis showed similar findings. There were no significant differences in binary restenosis rate, major adverse cardiac events, and late-acquired incomplete stent apposition. Conclusions Compared to sirolimus-eluting stents, the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction. Although there was no significant difference in 1-year clinical outcomes, the clinical implication of increased late lumen loss should be further studied.
文摘Background The benefits and safety of sirolimus-eluting stent (SES) have not been systematically quantified in different trials in ST-segment elevation myocardial infarction (STEMI) patients with primary or rescue percutaneous coronary intervention (PCI). A meta-analysis of randomised trials comparing SES and bare-metal stent (BMS) was performed. Methods A systematic literature search was conducted to identify all randomized clinical trials. The primary outcome was the rate of major adverse cardiac events (MACEs). The secondary outcomes included death, recurrent myocardial infarction, recurrent revascularization, and stent thrombosis.Results Totally, 1973 STEMI patients were enrolled in seven eligible randomized trials comparing SES with BMS. The pooled rate of major adverse cardiac events was significantly lower in the SES group than in the BMS group (9.7% vs 20.3%, OR 2.45, 95% Cl 1.88-3.19, P 〈 0.00001). No significant difference in all causes of death was found between the SES and BMS groups, as well as in the pooled recurrent myocardial infarction rates. The pooled recurrent revascularization rate was significantly lower in the SES group than in the BMS group (5.1% vs 14.8%, OR 3.30, 95%CI 2.37-4.60, P 〈 0.00001). No significant difference was found between the pooled rates of stent thrombosis (1.2% in the SES group and 2.0% in the BMS group, OR 1.61, 95%CI 0.79-3.26, P = 0.19).Conclusions SES is associated with a decreased risk of major adverse cardiac events compared with BMS by the greater reduction in repeat revascularization in STEMI patients. Larger trials with longer follow up are warranted to better define the role of SES in STEMI.
文摘Acute total or subtotal occlusion of left main coronary artery (LMCA) is a catastrophic and mostly fatal event. Patients may present with cardiogenic shock and die whenever this event occurs. Survival is strongly dependent on the presence of collateral blood flow to the left coronary artery or a dominant right coronary artery, and emergency intervention for preserving the left ventricular function. Here, we present a case of a 14-year-old boy with subtotal occlusion of the LMCA accompanying acute myocardial infarction probably caused by congenital syphilis according to his positive serum syphilis antibody. His survival was closely associated with a dominant right coronary artery and timely thrombolytic therapy. Finally, he was treated with angioplasty and paclitaxel-eluting stent implantation. He was followed up after stenting and was doing quite well at the time when we wrote this paper.
文摘Background: Vaccines remain the only viable and safe option to control transmission and minimise disease sequelae during the COVID-19 pandemic. Whilst multiple vaccines are available, evidence has emerged regarding the association between the ChAdOx1 nCoV-19 vaccine, platelets and thrombosis, manifesting in thrombotic thrombocytopaenia. Case Summary: We report a case of recurrent coronary artery thrombosis on triple antithrombotic therapy, namely aspirin, clopidogrel, and continuous intravenous heparin, nine days after the ChAdOx1 nCoV-19 vaccine, in a 63-year-old female with no significant history of cardiovascular disease. Conclusion: This case may suggest that the association between platelets, SARS-CoV-2, the ChAdOx1 nCoV-19 vaccine, and coronary thrombosis may remain incompletely understood and warrants further study. Clinicians should remain on high alert if presented with similar circumstances.
文摘Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass grafting (CABG) surgeries may protect the patient against ischemic complications due to acute stent occlusion. This issue, however, is controversial. Loss of bypass graft function may occur in the early stages due to the competition between native flow and graft flow. In the present study, the effects of bypass surgery to an artery with a patent stent on the outcomes were investigated. Methods: Fifty nine patients who had undergone isolated CABG surgery within 6 weeks after a successful primary PTCA/stent placement were included in the study. Patients who had undergone emergency operation due to suspicion of acute stent occlusion and the redo cases were excluded in the study. Patients were divided into two groups;those with (Group P, protected) and without (Group NP;non-protected) coronary bypass to an artery with a patent stent. Preoperative, operative and postoperative data were collected retrospectively from the patient files. The need for urgent revascularization was recorded postoperatively. Mann-Whitney U test was used for the analysis of continuous variables, whereas categorical variables were analyzed either using Pearson's chisquare test or Fisher's exact test. Results: Of 59 patients, 35 underwent bypass surgery to the artery with patent stent, whereas bypass was not performed on 24 patients. It was observed that dual antiplatelet therapy had been performed on 20% of the patients in Group P and 87.5% of those in Group NP (p = 0.001). No acute ischemic change due to stent occlusion was determined in Group P, whereas it was observed in one patient in Group NP (p = 0.4). The prevalence of hospital mortality was found to be 8.6% and 8.3% in Group P and Group NP, respectively (p = 1). Conclusions: Although it was not statistically significant, it was observed that bypass surgery might have a protective effect against stent occlusion in patients who underwent bypass surgery. However, postoperative dual antiplatelet therapy substantially prevented stent occlusion in those without bypass surgery. On the other hand, stent-supported coronary circulation may be unsafe in case of discontinuation of clopidogrel therapy. Therefore, it was suggested that performing bypass surgery to an artery with a patent stent would be more reasonable in patients who underwent semi-urgent CABG surgery.
文摘Coronary stent fracture (SF) is a rare but potentially serious complication of coronary arterystenting. Here we report a case of acute myocardial infarction as a consequence of very late in-stent thrombosis due to multiple stent fractures at 8 sites and multiple stent malapposition formation four years after a sirolimus-eluting stent implantation (Firebird, Microport, Shanghai, China).