Assessment of vascular healing with optical coherence tomography in patients with acute myocardial ;infarction after receiving drug-eluting stent implantation / 介入放射学杂志

Objective By using optical coherence tomography (OCT) to evaluate the vascular neointimal hyperplasia and the stent strut coverage degree in patients with acute myocardial infarction (AMI) and in patients with stable angina (SA) one year after receiving drug-eluting stent (DES) implantation, and to compare the clinical results between the two groups. Methods A total of 39 patients, who received DES implantation due to coronary heart disease, including AMI (n=16, AMI group) and SA (n=23, SA group), during the period from March 2011 to July 2012, were enrolled in this study. One year after DES implantation, coronary angiography and OCT reexaminations were performed in all patients. The neointimal hyperplasia (NIH) thickness, NIH area, NIH volume, strut coverage and apposition rate were determined with OCT. The results were compared between the two groups. Results OCT measuring results showed that the mean NIH thickness of AMI group and SA group was ( 66 . 8 ± 20 . 7 ) mm and ( 121 . 6 ± 135 . 7 ) mm respectively (P=0.022); the NIH volume ratio were 5.66%±3.18% and 11.88%±8.22% respectively (P=0.005); the percentage of cross-section with NIH thickness over 100 μm was 22.56%±23.99% and 40.14%± 30.01% respectively (P=0.034); and the percentage of overall stent strut coverage was 89.27%±6.40% and 93.42%±7.03% respectively (P=0.007). All the above mentioned data of AMI group were obviously lower than those of SA group. Conclusion After DES implantation, the intimal repair, intimal hyperplasia and stent strut coverage in AMI patients are poorer.

The inhibition effect of novel drug-eluting balloon on obstructive peripheral arterial disease of lower ;extremity：an experimental study in rabbit models / 介入放射学杂志

Objective To investigate the possible inhibition effect of a domestic novel drug-eluting balloon(DEB), such as controlling the vascular stenosis and reducing the intimal hyperplasia, on obstructive peripheral arterial disease (PAD) of lower extremity. Methods Male New Zealand rabbits (weighted 2.5-3.0 kg) were used for this study. Mustang bare metal stents (BMS) were separately implanted at both the proximal and distal site of abdominal aorta to establish the PAD models in rabbits. Bare balloon (PTA group) or drug-eluting balloon (DEB group) was separately used to dilate the stent segment of the aorta. The animals were sacrificed 28 days after the treatment. The aorta stent specimens were collected and sent for pathologic examination. Using Masson staining method the degree of intimal hyperplasia was estimated and the expression level of paclitaxel-targeted β-tubulin was determined with immunohistochemical method. The results were compared between the two groups. Results Morphologically, both the degree of intimal hyperplasia and the vascular stenosis rate in DEB group were significantly lower than those in PTA group. Meanwhile, immunohistochemical examination of paclitaxel-targeted β-tubulin indicated that its expression level in DEB group was obviously higher than that in PTA group. Conclusion This experimental study indicates that the domestic novel DEB has potential inhibition effect in respect of controlling the loss of lumen as well as reducing the intimal hyperplasia. This novel DEB carries excellent property, suggesting the possibility to use DEB in clinical treatment of PAD.

Improved outcomes from transradial over transfemoral access in primary percutaneous coronary intervention for patients with acute ST-segment elevation myocardial infarction and upstream use of tirofiban / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transradial access has been increasingly used during primary percutaneous coronary intervention (PCI) for patients with acute ST-segment elevation myocardial infarction (STEMI) in last decade. Clinical benefits of upstream use of tirfiban therapy in STEMI patients treated by primary PCI have been reported. We investigated the merits of transradial vs. transfemoral access in primary PCI for STEMI patients with upstream use of tirofiban.</p><p><b>METHODS</b>Patients with STEMI treated with tirofiban between December 2006 and October 2012 then by primary PCI were compared between transradial (n = 298) and transfemoral (n = 314) access. Baseline demographics, angiographic and PCI features and primary endpoint of major adverse cardiac events (MACE) at 30-day clinical follow-up were recorded.</p><p><b>RESULTS</b>Baseline and procedural characteristics were comparable between the two groups, apart from more patients in transradial group had hypertension and were treated by thrombus aspiration during primary PCI. Significantly fewer MACE occurred in the transradial group (5.4%) compared with the transfemoral group (9.9%) at 30-day clinical follow-up. Major bleeding events at 30-day clinical follow-up were 0 in transradial group and in 2.9% of transfemoral group. Multivariate analysis confirmed transradial approach as an independent negative predictor of 30-day MACE (HR 0.68; 95%CI 0.35 - 0.91; P = 0.03).</p><p><b>CONCLUSIONS</b>Using transradial approach in primary PCI for acute STEMI infarction patients treated with tirofiban was clearly beneficial in reducing bleeding complications and improving 30-day clinical outcomes.</p>

Impact of angina prior to acute ST-elevation myocardial infarction on short-term outcomes after primary percutaneous coronary intervention: results from the Shanghai Registry of Acute Coronary Syndrome (SRACE) / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction (STEMI) remains an interesting issue of investigation particularly in the era of percutaneous coronary intervention (PCI). This study aimed to assess the impact of angina prior to STEMI on short-term clinical outcomes in patients with acute STEMI undergoing primary PCI.</p><p><b>METHODS</b>Among a total of 875 consecutive patients with STEMI undergoing primary PCI, 292 had episodes of angina within 24 hours of STEMI (PA group) and the remaining 583 were free of anginal symptoms (non-PA group). Clinical characteristics, angiographic and procedural features, and in-hospital and 30-day outcomes were compared between the two groups.</p><p><b>RESULTS</b>Diabetes was less common (17.5% vs. 23.3%, P = 0.04) and symptom-to-door time was shortened ((191.6 ± 96.8) minutes vs. (357.2 ± 341.9) minutes, P < 0.001) in the PA group than in the non-PA group. Patients with angina prior to STEMI had fewer totally or nearly totally occluded infarct-related artery (TIMI flow grade 0 - 1) at initial angiography (75.0% vs. 90.7%, P < 0.001), and achieved more TIMI flow grade 3 after primary PCI (84.2% vs. 78.2%, P = 0.04). These were associated with higher rates of overall procedural success (95.9% vs. 91.8%, P = 0.02) and of complete ST-segment resolution at 90 minutes after the procedure (51.7% vs. 40.3%, P = 0.001). During a 30-day clinical follow-up, the left ventricular ejection fraction was significantly improved ((53.0 ± 8.6)% vs. (51.1 ± 9.7)%, P = 0.002) and the primary endpoint of major adverse cardiac events was reduced in the PA group (7.2% vs. 12.7%, P = 0.01).</p><p><b>CONCLUSION</b>Presence of angina prior to acute STEMI is associated with better outcome at a 30-day clinical follow-up in patients undergoing primary PCI.</p>

Intravascular ultrasound evaluation on the efficacy of national made Firebird stents comparing with Cypher stents / 中华心血管病杂志

<p><b>OBJECTIVE</b>Intravascular ultrasound (IVUS) was used to compare the effects on neointimal hyperplasia inhibition between national made Firebird stents and Cypher stents in patients with coronary artery disease.</p><p><b>METHODS</b>From May 2003 to March 2007, 215 patients with 317 native lesions received either Firebird stent (147 lesions of 108 patients, Firebird group) or Cypher stent implantation (138 lesions of 107 patients, Cypher group). Quantitative coronary angiography (QCA) and IVUS were performed at one-year follow-up.</p><p><b>RESULTS</b>The baseline clinical and angiographic characteristics between the two groups were similar, but post procedural minimal lumen diameter was significantly larger in Firebird group than that in Cypher group [(2.88 +/- 0.43) mm vs. (2.78 +/- 0.33) mm, P < 0.05]. follow-up QCA results showed that in-stent late loss [(0.17 +/- 0.29) mm vs. (0.16 +/- 0.27) mm, P > 0.05] and in-segment late loss [(0.18 +/- 0.36) mm vs. (0.20 +/- 0.32) mm, P > 0.05] was similar between Firebird group and Cypher group, while stent cross sectional area (CSA) [(6.99 +/- 2.25) mm(2) vs. (6.46 +/- 1.71) mm(2), P < 0.05], lumen CSA [(6.89 +/- 2.30) mm(2) vs. (6.36 +/- 1.73) mm(2), P < 0.05], stent volume [(162.5 +/- 68.9) m(3) vs. (140.8 +/- 57.9) mm(3), P < 0.01], lumen volume [(160.4 +/- 69.5) mm(3) vs. (138.6 +/- 57.6) mm(3), P < 0.01] and minimal stent CSA [(5.40 +/- 1.85) mm(2) vs. (4.92 +/- 1.43) mm(2), P < 0.05] were larger in Firebird group than those in Cypher group. IVUS analysis showed that there was no significant difference in neointimal hyperplasia volume [(2.09 +/- 5.46) mm(3) vs. (2.23 +/- 6.50) mm(3), P > 0.05] and percentage of volume obstruction [(1.68 +/- 5.84)% vs. (1.59 +/- 4.10)%, P > 0.05] between the two groups.</p><p><b>CONCLUSION</b>Implantation of Firebird stent was associated with low restenosis rate and both Firebird and Cypher stents equally and effectively inhibited neointimal hyperplasia.</p>

Association between late incomplete stent apposition after sirolimus eluting stent implantation and clinical outcomes in patients with acute coronary syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>The impact of late incomplete stent apposition (ISA) post sirolimus eluting stent (SES) implantation in patients with acute coronary syndrome (ACS) on long-term clinical outcomes remains controversial. The aim of the present study was to evaluate the association between late ISA and clinical outcomes in patients with ACS compared with that with stable angina (SA).</p><p><b>METHODS</b>From February 2005 to March 2007, 54 ACS patients and 83 SA patients were enrolled in this study, late ISA was determined by means of three-dimensional volumetric intravascular ultrasound (IVUS) analyses one year after SES implantation and clinical outcomes one year post IVUS were obtained in these patients.</p><p><b>RESULTS</b>In 219 treated lesions of the 137 patients, late ISA was documented in 25 lesions in 16 patients (20 ISA in 12 ACS patients vs. 5 ISA in 4 SA patients, P<0.001). Though lumen area in reference and stented segment, neointimal hyperplasia (NIH) area and percentage of NIH in stented segment, and external elastic membrane (EEM) area in reference segment were similar between two groups, EEM area in stented segment [(15.34+/-5.44) mm2 vs. (13.83+/-4.51) mm2, P=0.026], stented/reference segment EEM area ratio (1.13+/-0.22 vs. 1.02+/-0.18, P<0.001), plaque and media area [(8.43+/-3.93) mm2 vs. (7.01+/-2.93) mm2, P=0.002] was significantly lager in ACS group than that in SA group. Multivariable logistic analysis showed that ACS (OR 6.477 with 95% CI from 2.297 to 18.263, P<0.001) and stent length>or=23 mm (OR 3.680 with 95% CI from 1.181 to 11.469, P=0.025) were main independent factors of occurrence of late ISA. Incidence of main adverse cardiac events (MACE) one year post IVUS was similar between the two groups.</p><p><b>CONCLUSION</b>Compared with patients with SA, ACS patients had larger stented segment EEM area, plaque and media area as well as increased incidence of ISA. However, the incidence of MACE was similar in ACS and SA patients one year after IVUS.</p>

Acute coronary syndrome is an independent risk factor for late incomplete stent apposition after sirolimus-eluting stent implantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Late incomplete stent apposition (ISA) may occur after drug-eluting stent implantation, affecting long-term clinical outcomes. This study aimed to evaluate the impact of clinical presentations of coronary artery disease on late ISA after percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) by means of three-dimensional volumetric intravascular ultrasound (IVUS) analyses.</p><p><b>METHODS</b>One hundred and thirty-seven patients with coronary artery disease received SES implantation during PCI and had repeat angiography with IVUS examination. All patients were followed up one year after the procedure.</p><p><b>RESULTS</b>In overall 219 treated lesions (137 patients), late ISA was identified in 25 lesions (16 patients). Clinical diagnosis of acute coronary syndrome (ACS) and use of long stents were more common in patients with than in those without late ISA. Patients with late ISA had greater external elastic membrane (EEM) area in stented segment ((15.34 +/- 5.44) vs (13.83 +/- 4.51) mm(2), P = 0.026), stented-to-reference segment EEM area ratio (1.13 +/- 0.22 vs 1.02 +/- 0.18, P < 0.001), and plaque and media area ((8.43 +/- 3.93) vs (7.01 +/- 2.93) mm(2), P = 0.002) than in those without late ISA. Multivariate Logistic regression analysis showed that clinical diagnosis of ACS and use of long stents were independent risk factors for late ISA (OR 6.477, 95% CI 2.297 - 18.263, P < 0.001; OR 3.680, 95% CI 1.181 - 11.469, P = 0.025; respectively). During one-year follow-up after IVUS examination, the rate of very late stent thrombosis tended to be higher in patients with than in those without late ISA (18.7% vs 3.3%, P = 0.051).</p><p><b>CONCLUSIONS</b>The occurrence of late ISA after SES implantation may be related to clinical status, use of long stents, and marked positive vessel remodeling. Late ISA tended to increase the rate of very late stent thrombosis during follow-up, highlighting the importance of long-term dual antiplatelet therapy for these patients.</p>

Comparative intravascular ultrasound study on neointimal hyperplasia after implantation of Firebird~(TM) stent and Taxus~(TM) stent / 中国介入心脏病学杂志

Objective To compare the effect of inhibiting neointimal hyperplasia between domestic sirolimus eluting stent(Firebird TM stent)and the TaxusTM stent by IVUS.Methods From May 2003 to June 2007,168 patients with 236 native lesions underwent DES implantation,of which,108 patients(147 lesions)were implanted with the FirebirdTM stents and the other 60 patients(89 lesions)were implanted with the TaxusTM stent.Quantitative angiography(QCA)and intravascular ultrasound(IVUS)analysis were performed at one-year follow-up.Results The baseline clinical and angiographic characteristics between the two groups were similar.There were less in-stent late loss(0.17?0.29 mm vs 0.43?0.51 mm,P0.05).But the Absolute and relative measwements of intimal hyperplasia including manifested as intimal hyperplasia area(0.35?0.58 mm2 vs 1.29?1.26 mm2),percentage of intimal hyperplasia area(5.45%?9.26% vs 17.38%?13.75%),percentage of maximal intimal hyperplasia area(9.41%?14.15% vs 31.56%?20.99%),intimal hyperplasia volume(2.09?5.46 mm3 vs 13.43?18.59 mm3)and percentage of intimal hyperplasia volume(1.68%?5.84% vs 8.62%?9.90%)were lower in the Firebird stent group than those in the Taxus stent group(all P