Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device （Invatec, Italy） versus ...Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device （Invatec, Italy） versus Guardwire Plus device （Medtronic, USA） before percutaneous coronary intervention （PCI） were compared in patients with acute inferior ST-segment-elevation myocardial infarction （STEMI） for less than 12 hours, thrombolysis in myocardial infarction （TIMI） flow grade 0 to 1, and total occlusion of the proximal right coronary artery （≥3 mm in diameter） in a prospective randomized single-center study. Methods The primary end point was the magnitude of ST-segment resolution （STR） （〉70%） measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume （LVEDV）, left ventricle ejection fraction （LVEF） and major adverse cardiac events （MACEs） including death, myocardial infarction, target vessel revascularization and stroke at 30 days. Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age （（60±14） years vs （60±13） years）, male （82% vs 84%）, diabetes （31% vs 28%）, previous coronary artery disease （25% vs 23%）, onset-to-angiogram （（350±185） min vs （345±180） min）, and use of glycoprotein lib/llia inhibitor （11% vs 13%）. The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution 〉70% （57% vs 59%; P〉0.05）. Similar slow flow/no-reflow rates were observed in the Diver CE group （8%） and the Guardwire Plus group （7%）. TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively （P〉0.05）. Myocardial blush grade 3 was similar （70% vs 72%; P〉0.05）. Thirty-day clinical outcome was comparable （LVEF, 0.54±0.12 vs 0.53 ±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P〉0.05, respectively）. Conclusions Removal of thrombus burden with the Diver CE catheter before stenting leads to similar improvement of myocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery （≥3 mm in diameter） compared with the Guardwire Plus device, as illustrated by a reduced risk of distal embolization and improved ST-segment resolution.展开更多
Background There are few evidences about the value of drug eluting stent in patients with ST-segment elevation myocardial infarction （STEMI）. We prospectively designed a randomized controlled trial to compare the sa...Background There are few evidences about the value of drug eluting stent in patients with ST-segment elevation myocardial infarction （STEMI）. We prospectively designed a randomized controlled trial to compare the safety and efficacy of Firebird sirolimus eluting stent （Firebird stent） and bare metal stent （BMS）. Methods Patients with STEMI enrolled during one year period were randomized to undergo implantation of Firebird stent or BMS, and clinical and angiographic follow-up. The primary endpoint of the present study was in-lesion late lumen loss （LLL） at 6 months, and secondary endpoint includes stent thrombosis and major adverse cardiac events （MACE） at 6 months. Results During one year period, 156 patients were randomized into the Firebird stent group （101 patients with an average age of 57.8 years） or the BMS group （55 patients with 59.7 years on average）. Six-month angiographic follow-up was available in 66.3% and 63.7% of patients assigned to Firebird stent and BMS, respectively. At 6-month follow-up, mortality, target vessel revascularization （TVR） and MACE were 2.0%, 6.9% and 9.9% in the Firebird stent group, while 3.6%, 30.9% and 36.4% in the BMS group （P〈0.05）. Subacute thrombosis occurred in 1 patient in both groups, respectively. The mean LLL was 0.18 mm in the Firebird stent group versus 0.72 mm in the BMS group. Conclusion Implantation of Firebird sirolimus eluting stent for STEMI may greatly reduce TVR and MACE at 6 months with low incidence of acute/subacute stent thrombosis compared with BMS.展开更多
文摘Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device （Invatec, Italy） versus Guardwire Plus device （Medtronic, USA） before percutaneous coronary intervention （PCI） were compared in patients with acute inferior ST-segment-elevation myocardial infarction （STEMI） for less than 12 hours, thrombolysis in myocardial infarction （TIMI） flow grade 0 to 1, and total occlusion of the proximal right coronary artery （≥3 mm in diameter） in a prospective randomized single-center study. Methods The primary end point was the magnitude of ST-segment resolution （STR） （〉70%） measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume （LVEDV）, left ventricle ejection fraction （LVEF） and major adverse cardiac events （MACEs） including death, myocardial infarction, target vessel revascularization and stroke at 30 days. Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age （（60±14） years vs （60±13） years）, male （82% vs 84%）, diabetes （31% vs 28%）, previous coronary artery disease （25% vs 23%）, onset-to-angiogram （（350±185） min vs （345±180） min）, and use of glycoprotein lib/llia inhibitor （11% vs 13%）. The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution 〉70% （57% vs 59%; P〉0.05）. Similar slow flow/no-reflow rates were observed in the Diver CE group （8%） and the Guardwire Plus group （7%）. TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively （P〉0.05）. Myocardial blush grade 3 was similar （70% vs 72%; P〉0.05）. Thirty-day clinical outcome was comparable （LVEF, 0.54±0.12 vs 0.53 ±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P〉0.05, respectively）. Conclusions Removal of thrombus burden with the Diver CE catheter before stenting leads to similar improvement of myocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery （≥3 mm in diameter） compared with the Guardwire Plus device, as illustrated by a reduced risk of distal embolization and improved ST-segment resolution.
文摘Background There are few evidences about the value of drug eluting stent in patients with ST-segment elevation myocardial infarction （STEMI）. We prospectively designed a randomized controlled trial to compare the safety and efficacy of Firebird sirolimus eluting stent （Firebird stent） and bare metal stent （BMS）. Methods Patients with STEMI enrolled during one year period were randomized to undergo implantation of Firebird stent or BMS, and clinical and angiographic follow-up. The primary endpoint of the present study was in-lesion late lumen loss （LLL） at 6 months, and secondary endpoint includes stent thrombosis and major adverse cardiac events （MACE） at 6 months. Results During one year period, 156 patients were randomized into the Firebird stent group （101 patients with an average age of 57.8 years） or the BMS group （55 patients with 59.7 years on average）. Six-month angiographic follow-up was available in 66.3% and 63.7% of patients assigned to Firebird stent and BMS, respectively. At 6-month follow-up, mortality, target vessel revascularization （TVR） and MACE were 2.0%, 6.9% and 9.9% in the Firebird stent group, while 3.6%, 30.9% and 36.4% in the BMS group （P〈0.05）. Subacute thrombosis occurred in 1 patient in both groups, respectively. The mean LLL was 0.18 mm in the Firebird stent group versus 0.72 mm in the BMS group. Conclusion Implantation of Firebird sirolimus eluting stent for STEMI may greatly reduce TVR and MACE at 6 months with low incidence of acute/subacute stent thrombosis compared with BMS.
