In-hospital and late clinical outcomes of direct stenting strategy versus stenting after predilatation for the treatment of coronary artery lesions.

BACKGROUND: Direct stenting without balloon dilatation may reduce procedural costs and duration, and hypothetically, the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after predilatation (PS) in our routine clinical practice. METHODS: One thousand six hundred and three patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours, highly calcified lesions, total occlusions, or lesion in a saphenous graft were excluded. The baseline, angiographic, and procedural data, in-hospital outcomes and follow-up data were recorded in our database, and analyzed with appropriate statistical methods. RESULTS: Eight hundred and fifty-seven patients (53.5%) were treated with DS, whereas 746 of them (46.5%) underwent PS. In the DS group, lesions were shorter in length, larger in diameter, and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were less frequent (p < 0.001). In univariate analysis, dissection and non-Q-wave MI occurred less frequently in this group (0.2% and 0.6% vs 3.9% and 2.1%, p < 0.001 and p 7 = 0.01, respectively). However, the cumulative major adverse cardiac events (MACE) did not differ significantly (4.9% vs 4.6%, p = 0.79). In multivariate analysis, direct stenting reduced the risk of dissection (OR = 0.07, 95% CI: 0.01-0.33), but, neither the cumulative endpoint of MACE (OR = 1.1, 95% CI = 0.58-2.11, p = 0.7) nor its constructing components were different between the groups. CONCLUSIONS: Direct stenting in real world has at least similar long-term outcomes with patients treated with stenting after predilatation and is associated with lower dissection rate.

Association between hepatitis B surface antibody seropositivity and coronary artery disease.

BACKGROUND: Specific infectious agents have been found to be related to the pathogenesis of coronary atherosclerosis. AIMS: We assessed the possible association between angiographically proven coronary artery disease (CAD) and hepatitis B surface antibody (HBS Ab) seropositivity in a population with relatively high prevalence of hepatitis B virus (HBV) infection. SETTING AND DESIGN: This was a cross-sectional study. MATERIALS AND METHODS: We analyzed data from 830 consecutive subjects undergoing coronary angiography, including angiographic results reported by two cardiologists for inter-observer reliability and assessment of HBS Ab status determined by enzyme-linked immunosorbent assay (ELISA). STATISTICAL ANALYSIS USED: Chi-square test or Fisher's exact test, independent two-sample t test and the Pearson's Correlation Coefficient test were used, as required. Statistics were performed using SPSS software version 13 (SPSS, Chicago, IL). RESULTS: Two hundred forty-nine (30%) subjects had normal angiogram or minimal CAD, and 581 (70%) had significant CAD in at least one major coronary artery. In patients with CAD and in patients without angiographic evidence of significant atherosclerosis, 28.7% and 28.9% respectively were positive for HBV (P=0.954). Mean C-reactive protein levels in subjects with positive and negative HBS Ab were 10.77+/-8.37 mg/L versus 10.33+/-7.64 mg/L respectively (P=0.465). However, C-reactive protein levels in CAD group were significantly higher (P<0.001). CONCLUSIONS: Our results suggested hepatitis B surface antibody seropositivity has no relationship with coronary artery disease. Moreover, no significant linear correlation exists between HBS Ab and C-reactive protein levels. However, as previously shown, C-reactive protein level in patients with coronary artery disease is significantly higher than in patients with normal coronary arteries.

Premedication for coronary angiography: effects on anxiety and hemodynamic status.

AIM: This study was designed to compare the outcomes of two current methods of premedication, for coronary angiography with placebo, on the level of anxiety and hemodynamic status. METHODS AND RESULTS: In all, 151 patients referring for coronary angiography were randomized into three groups with equal populations. The first group (group M) received 0.02 mg/kg intravenous midazolam; the second (group DP7rpar; received intramuscular injection of 5mg diazepam + 25 mg promethazine; and the third (group P) received 2cc of intravenous normal saline solution. Vital signs, blood pressure, and peripheral O2 saturation were recorded in specifically-designed questionnaires. The level of anxiety before and after angiography was documented according to the Visual Analog Scale. Patients in the group M accidentally had higher pre-procedural anxiety level (p < 0.05). There was no significant difference in pulse rate, respiratory rate, and mean blood pressure (BP) between these groups prior to angiography. In the group M, diastolic BP decreased more significantly than the other 2 groups during angiography (p < 0.05). Although number of punctures, pain at catheterization site, dose of lidocaine, level of consciousness, and patient satisfaction did not show a significant difference between the three groups; midazolam induced higher level of amnesia than the other 2 groups and the physicians were more satisfied with it only compared with diazepam + promethazine (p < 0.05). CONCLUSION: Because of the importance of hemodynamic stability and comfort during angiography, non-pharmacologic approaches are preferred. In case of severity and persistence of autonomic system stimulation, the least effective dose of midazolam for a short period of time may be used.