One-year outcome of everolimus-eluting stents versus biolimus-eluting stents in patients undergoing percutaneous coronary intervention

Background: The biolimus-eluting stent [BES], with a biodegradable polymer, has not been previously compared with the everolimus-eluting stent [EES], as a second-generation drug-eluting stent [DES].We sought to compare the 1-year outcome between the PROMUS[TM] stent [EES type] and the BioMatrix[TM] stent [BES type]

Methods: From March 2008 to September 2011, all patients treated with the PROMUS[TM] stent or the BioMatrix[TM] stent for coronary artery stenosis at Tehran Heart Center were enrolled. The primary end points were 1-year adverse events, comprising death, myocardial infarction, target vessel revascularization, and target lesion revascularization. The secondary end point was stent thrombosis. The Cox proportional hazard model was used to assess the adjusted association between the stent type and the follow-up outcome

Results: From 949 patients [66.3% male, mean age =59.48 +/- 10.46 y] with 1,018 treated lesions, 591 patients [630 lesions, 65.1% male, mean age = 59.24 +/- 10.23 y] received the PROMUS[TM] stent and 358 patients [388 lesions, 68.2% male, mean age = 59.88 +/- 10.83 y] were treated with the BioMatrix[TM] stent. Before adjustment, the rate of the primary end points was 3.2% and 3.4% in the EES and BES, respectively [p value = 0.925, HR [EES to BES] = 1.035, 95% CI: 0.50 to 2.13]. The rate of stent thrombosis was 2% and 1.7% in the EES and BES, respectively [p value = 0.698]. After adjustment on confounder variables, there was no statistically significant difference in major adverse cardiac events between the PROMUS[TM] stent and the BioMatrix[TM] stent [p value = 0.598, HR [EES to BES] = 0.817, 95% CI: 0.39 to 1.73]

Conclusion: At 1 year's follow-up, the BES and EES showed similar safety and efficacy rates in the patients undergoing percutaneous coronary intervention with a relatively low rate of adverse events in the 2 groups

Opium consumption and mid-term outcome of percutaneous coronary intervention in men

Controversy persists over the potential benefits/harms of opium consumption in coronary heart disease. This study investigated the association between 12 months' major adverse cardiac events [MACE] and pre-procedural opium consumption among patients undergoing percutaneous coronary intervention [PCI]. Retrospectively, 1545 consecutive men who underwent PCI between 21[st] June 2009 and 20[th] June 2010 at Tehran Heart Center and were registered in the PCI Databank were entered into this cohort study. The occurrence of MACE, defined as cardiac death, non-fatal myocardial infarction, and need for target vessel revascularization [TVR] or target lesion revascularization [TLR], was compared between two groups of opium consumers and non-consumers in 350 [22.7%] patients. Sixty-four [0.86%] patients expired within 12 months. After adjustment for potential confounders, analysis revealed that opium consumption had no significant relationship with 12 months' MACE [11[3.1%] vs. 53[4.4%]; p value = 0.286, among opium users vs. non users, respectively]. Furthermore, the different components of MACE, including target vessel revascularization, target lesion revascularization, coronary artery bypass graft, and non-fatal myocardial infarction, were not significantly related to opium use. Pre-procedural opium usage in patients undergoing PCI was not associated with 12 months' MACE

Mean platelet volume as a predictor of one-year major adverse cardiac events following elective percutaneous coronary interventions

Mean platelet volume [MPV] correlates with platelet activity. The relation between MPV and long-term outcome in patients undergoing percutaneous coronary intervention [PCI] has been investigated in several studies. The aim of the present study was to investigate the utility of MPV in prognosticating the long-term outcome after elective PCI. The study cohort included 2627 patients undergoing elective PCI between September 2008 and June 2010, whose baseline MPV measurements before PCI were available. The patients were divided into three groups of MPV < 9.1 fL, MPV = 9.1 to 10 fL, and MPV > 10 fL, and they were assessed for developing major adverse cardiac events [MACE], comprising death, myocardial infarction [MI], target vessel revascularization [TVR], and target lesion revascularization [TLR] over a one-year follow-up. Of 2539 patients, major adverse cardiac events [MACE] at one year occurred in 77 [3.0%] patients, including mortality in 26 [1.0%]. The patients in the highest tertile [MPV > 10 fL] had no increased frequency of MACE compared to those in the mid [9.1 to 10 fL] and lowest [< 9.1 fL] tertiles [3.3%, 2.2%, and 3.8%, respectively; p value = 0.14]. No significant differences were found for each of the primary endpoints among the MPV tertiles. In multivariate logistic regression, we investigated the association between high MPV and total MACE [OR = 1.10, 95%CI: 0.69-1.77; p value = 0.68], death [OR = 1.14, 95%CI: 0.51-2.54; p value = 0.74], and non-fatal MI [OR = 1.85, 95%CI: 0.73-4.67; p value = 0.19] at one year's follow-up but MPV did not remain in the model in any of the cases. In the diabetic patients, the one-way analysis of variance demonstrated that mortality was 1.6% [4 patients] in the highest tertile, 0.8% [2 patients] in the mid tertile, and 0.5% [one patient] in the lowest tertile. There was no direct correlation between pre-procedural MPV and MACE in elective PCI. MPV can only be considered as an appropriate factor for predicting mortality in diabetic patients undergoing elective PCI

Impact of side-branch flow in coronary bifurcation intervention

The optimal strategy in percutaneous coronary intervention [PCI] for coronary artery bifurcation lesions has yet to be agreed upon. We compared a strategy for stenting the main vessel to provide a complete perfusion flow in the side branch, namely thrombolysis in myocardial infarction [TIMI] - III, with a strategy for intervention in both the main vessel and the side branch [MV + SB]. This retrospective study utilized data on 258 consecutive patients with bifurcation lesions scheduled for PCI at Tehran Heart Center between March 2003 and March 2008. The patients were followed up for 12 months, and the primary end point was a major adverse cardiac event [MACE], i.e. cardiac death, myocardial infarction, target-vessel revascularization, and target-lesion revascularization during the 12-month follow-up period. A total of 52.7% of the patients underwent PCI on the main vessel of the bifurcation lesions [MV group] and 47.3% with a similar lesion type received a percutaneous intervention on both the main vessel and the side branch [MV + SB group]. The total rate of MACE during the follow-up was 4.3% [11 patients]; the rate was not significantly different between the MV and MV + SB groups [3.7% vs. 4.9%, respectively; p value = 0.622]. There was no association between MACE in performing a simple or complex interventional strategy to treat coronary bifurcation lesions when drawing the TIMI- III flow as a goal in a simple technique.

Effectiveness of two-year versus one-year use of dual antiplatelet therapy in reducing the risk of very late stent thrombosis after drug-eluting stent implantation

Impact of 12 months' versus 24 months' use of dual antiplatelet therapy on the prevalence of stent thrombosis in patients undergoing percutaneous coronary intervention [PCI] with the drug-eluting stent [DES] is not clear. As a result, duration of dual antiplatelet therapy is still under debate among interventionists. From March 2007 until August 2008, all consecutive patients with successful PCI who received at least one DES and were treated with dual antiplatelet therapy [Clopidogrel + Aspirin] were included. All the patients were followed up for more than 24 months [mean = 35.27 +/- 6.91 months] and surveyed for very late stent thrombosis and major cardiovascular events. From 961 patients eligible for the study, 399 [42%] discontinued Clopidogrel after 12 months and 562 [58%] continued Clopidogrel for 24 months. The clinical and procedural variables were compared between the two groups. In the 12 months' use group, two cases of definite thrombosis occurred at 18 and 13 months post PCI. In the 24 months' use group, 2 cases of definite thrombosis occurred at 14 and 28 months post PCI, one of them with stenting in a bifurcation lesion. Five cases of probable stent thrombosis were detected at 21, 28, 32, 33, and 34 months after the procedure. It is of note that amongst the 10 cases of stent thrombosis, only 1[10%] thrombosis occurred when the patient was on Clopidogrel and Aspirin and all the other 9 [90%] cases of thrombosis appeared after the discontinuation of the dual antiplatelet therapy. Extended use of dual antiplatelet therapy [for more than 12 months] was not significantly more effective than Aspirin monotherapy in reducing the risk of myocardial infarction or stent thrombosis, death from cardiac cause, and stroke

Effect of elective percutaneous coronary intervention on left ventricular function in patients with coronary artery disease

Coronary artery disease is one of the most common causes of mortality and morbidity across the world. Its treatment includes medical treatment, coronary artery bypass graft [CABG] and percutaneous coronary intervention [PCI]. The purpose of this study was to investigate the effect of PCI on echocardiographic findings of left ventricular [LV] systolic and diastolic function. 115 patients with coronary artery disease candidate for PCI were enrolled to our study. Echocardiography was done before PCI, the day after and 3-6 months later. LV systolic and diastolic function were measured and recorded. Echocardiographic finding compared with repeated measurement analysis. Mean age of the patients was 57.8 +/- 8.38 years. The mean Ejection Fraction [EF] was [%40.52 +/- 6.36] before, [%41.83 +/- 7.14] the day after, and [%44.0 +/- 7.89] 3-6 months after PCI. Diastolic dysfunction were mild to moderate before PCI, which in%74 [86 patients] were improved to mild dysfunction the day after PCI but not changed 3-6 months later [P<0.0001]. PCI improved LV ejection fraction, and LV diastolic function in our patient's population

Success rate, procedural complications and clinical outcomes of coronary interventions in octogenarians: a case-control study

Clinical trials of revascularization have routinely under-enrolled elderly subjects. Thus, symptom relief and improved survival might not apply to elderly patients, in whom the risk of mortality and disability from revascularization procedures seems to be high and co-morbidity is more prevalent. The present case control study was performed to draw a comparison in terms of the procedural success, procedural and in-hospital complications, and major adverse cardiac events [MACE] in a one-year follow-up of octogenarians [age >/= 80 years] with a selected matched younger control group in the Tehran Heart Center Angioplasty Registry. According to the Tehran Heart Center Interventional Registry of 9, 250 patients with a minimum follow-up period of one year between April 1993 and February 2010, 157 percutaneous coronary intervention [PCI] procedures were performed in 112 octogenarians. Additionally, 336 younger patients [459 PCI procedures] were selected from the database as the propensity-score matched controls. There were 147 [93.6%] and 441 [96.1%] successful PCI procedures in the elderly group and control group, respectively [p value = 0.204]. Procedural complications were seen in 5 [3.2%] of the elderly group and 16 [3.5%] of the control group [p value = 0.858]. Totally, 7 [6.3%] in-hospital complications occurred in the elderly group and 22 [6.8%] in the control group [p value = 0.866]. One-year MACE was seen in 9 [9.1%] of the elderly and 18 [5.8%] of the control group [p value = 0.26]. Procedural success and complications, in-hospital complications, and one-year MACE were not significantly different between our two study groups. Therefore, age alone should not be used as the sole criterion when considering revascularization procedures. Furthermore, PCI should not be refused in octogenarians if indicated

Correlation between the serum levels of uric acid and HS-CRP with the occurrence of early systolic failure of left ventricle following acute myocardial infarction

Recent studies show that, Inflammation plays an important role in the initiation and progression of atherosclerosis and in the pathogenesis of acute cardiovascular events. There is a possible association between ventricular dysfunction following acute myocardial infarction and high Sensitivity C-reactive protein [HS-CRP] and uric acid. In this study we assessed the relationship between HS-CRP and uric acid with LVEF and Killip Class in patients with acute myocardial infarction [AMI]. In a cross sectional study, 188 patients [63 females and 125 males] with AMI [STEMI] who were admitted in CCU ward in Emam Khomeini Hospital, Tehran/Iran, were entered. Uric acid and HS-CRP were measured within first day of admission. We measured ejection fraction [LVEF] and used Killip classification system. The mean age of patients was 60.4 +/- 9.2 years. The mean of uric acid was 5.9 +/- 1.6, 6.6 +/- 2.1, 7.1 +/- 2.1 and 9.4 +/- 1.3 in patients with Killip Class I, II, III and IV, respectively [P=0.005]. The mean of HS-CRP was 1.9 +/- 1.4, 14.2 +/- 10.9, 12.2 +/- 10.9 and 15.7 +/- 6.7 in patients with Killip Class I, II, III and IV, respectively [P=0.005]. There was a relationship between HS-CRP and LVEF [Correlation coefficient=-0.788, P<0.001], but there was not between uric acid and LVEF [Correlation coefficient=-0.111, P=0.129], The plasma concentration of C-reactive protein correlated with LVEF and Killip Class in patients with AMI but serum uric acid was just correlated with Killip Class IV. It seems that plasma concentrations of HS-CRP and uric acid are useful for prediction of development of heart failure in AMI patients. More future studies are necessary for final judgment