Long-term clinical outcomes of drug-eluting stents vs.bare-metal stents in Chinese geriatric patients

BACKGROUND & OBJECTIVE: Little is known about the relative efficacies of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and bare-metal stents (BMS) in elderly patients。 The objective of this study was to evaluate the clinical outcome for geriatric patients who received either DES or BMS。 METHODS: From January 2002 to October 2005, 199 consecutive Chinese geriatric patients (≥ 75 years old) underwent PCI with coronary DES or BMS implantation at our institution。 We analyzed the major clinical end points that included all-cause mortality, cardiovascular death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, and bleeding complications。 RESULTS: The three-year cumulative rates of all-cause mortality, cardiovascular death, and myocardial infarction were significantly lower in the DES group (6.3%,3.6%,5.4%) compared with the BMS group (16.2%,11.5%,14.9%; P <0.05)。 No significant differences were found in the three-year cumulative rate for target lesion revascularization (6.3% vs4.6%, P =0.61) or stent thrombosis (3.6% vs2.3%, P =0.70)。 Likewise, there were no statistically significant differences in the cumulative rate for intracranial hemorrhage, or major and minor hemorrhage at three years。 CONCLUSIONS: DES-based PCI was associated with a significant reduction in the three-year cumulative rate of all-cause mortality, cardiovascular death, and myocardial infarction compared with BMS, without increased risk of TLR, stent thrombosis, or bleeding complications at three years in this group of Chinese geriatric patients。

Risk of ischaemic and haemorrhagic stroke in Chinese undergoing percutaneous coronary intervention treated with potent P2Y12 inhibitor versus clopidogrel

Background Stroke after acute coronary syndrome(ACS)can be devastating.It is uncertain whether the risks of ischaemic stroke or intracranial haemorrhage(ICH)are associated with different choices of P2Y12 inhibitors(potent P2Y12 inhibitors such as ticagrelor and prasugrel vs clopidogrel).Even though East Asians are known to have different thrombotic and haemorrhagic profiles from Caucasians,data on Chinese patients are sparse.Method This was a retrospective cohort study conducting in Chinese patients with ACS who underwent first-ever percutaneous coronary intervention from 14 hospitals in Hong Kong between 2010 and 2017.The primary efficacy endpoint was ischaemic stroke.The secondary efficacy endpoint was a composite outcome of thrombotic events including all-cause mortality,non-fatal myocardial infarction and ischaemic stroke.The primary safety endpoint was ICH.The secondary safety endpoint was a composite of major bleeding events.Results After adjustment of baseline characteristics by 1:1 propensity score matching,a total of 6220 patients(3110 on each group)were analysed.Compared with clopidogrel,potent P2Y12 inhibitors were associated with a lower risk of ischaemic stroke(HR 0.57;95%CI 0.37 to 0.87;p=0.008)and a lower risk of thrombotic events(HR 0.77;95%CI 0.66 to 0.90;p=0.001).Potent P2Y12 inhibitor was associated with similar risk of ICH(HR 0.65;95%CI 0.34 to 1.25,p=0.20)and major bleeding(HR 0.83;95%CI 0.68 to 1.01,p=0.069).Conclusions Potent P2Y12 inhibitors were associated with a lower adjusted risk of ischaemic stroke and thrombotic events,compared with clopidogrel.The risks of ICH and major bleeding were similar.

Treatment of in stent coronary restenosis with excimer laser angioplasty

OBJECTIVE: To evaluate the efficacy and safety of excimer laser coronary angioplasty (ELCA) with adjunctive balloon angioplasty in patient with in-stent restenosis. METHODS: ELCA was performed in 20 patients of instent restenosis. All patients were symptomatic and had class III-IV angina. ELCA was performed with the Spectranetics CVX-300 System. The laser catheter of Vittesse C (concentric) and E (eccentric) with diameter of 1.4-2.0 mm was used. RESULTS: Laser catheter crossed all stenotic stents without difficulty. The lesion length was 4.6-51.2 mm, mean 20.7 +/- 13.7 mm, including 14 lesions > 10 mm. Laser treatment alone increased minimal lumen diameter (MLD) from 0.3 +/- 0.3 mm to 1.4 +/- 0.3 mm (P

ClinicalexperiencewiththecordiscoronarystentintheChinesepopulation

Objective To assess the safety and efficacy of the new Cordis coronary stent in the Chinese population.Patients A total of 32 patients recieved 34 Cordis stents (target lesions of 32) from July to December 1995 in our hospital. Vessel distribution was 18 LAD (53%), 8 Lcx (23.5%) and 8 RCA (23.5%).Methods All cases were studies retrospectively. The coronary lesions were predilated with standard balloon angioplasty followed by implantation of Cordis stents. The reference diameter of the vessels and the minimal luminal diameters (both before and after stent implantation) were measured by quantitative angiography. All patients were followed up at mean peroid of 3 months with regards to their symptoms and angiographic follow-up at 6 month's time were carried out in 8 patients.Results Delivery success was achieved in all lesions except 1 unsuccessful delivery due to failure to negotiate an acute angle of a left main vessel to LAD. Average MLD post stenting was satisfactory (0.53±0.36 mm vs 3.32±0.34 mm) compared to reference diameter of 3.13±0.4 mm. There was 1 patient with complication of subacute stent thrombosis. Another patient died 5 weeks later from non-ischaemic end stage heart failure secondary to severe aortic regurgitation. Loop seperations occurred in 2 stents (5.8%) during deployment.Conclusions The Cordis stent implantation is efficacious with high angiographic success rate. The strong radiopacity facilitates precise positioning of the stent in the target lesions. Our experience in the Chinese population is favourable. Stent deformity was possible. For smaller stents of 3 mm, higher pressure of balloon inflation for deployment followed by adequate anticoagulation is recommended. Further studies are required to investigate the long term restenosis rate.