The Clinical Effects of Drug-Eluting Stents for the Treatment of Coronary In-Stent Restenosis

BACKGROUND AND OBJECTIVES: Treating coronary in-stent restenosis (ISR) has become one of the major challenges for the interventional cardiologist. The aim of this study was to determine the feasibility and safety of treating ISR with drug eluting stents (DESs), and we also wanted to determine the effect of DESs on the prevention of recurrent restenosis. SUBJECTS AND METHODS: Eighty patients (age range: 60.9+/-6.4 year-old, males:females=63:17) with 82 ISR lesions that were treated successfully with DES (sirolimus- and paclitaxel-eluting stents) were enrolled in our study. Five patients received 2 stents for a total mean of 1.1+/-0.3 stents per lesion. The major adverse cardiac events (MACEs) during hospitalization, at 30 days and at 6 months after the stenting were analyzed along with the coronary angiographic findings. RESULTS: At the time of DES implantation, the mean number of ISRs was 1.4+/-0.9, and the patterns of ISR according to the Mehran classification were IB in 9 lesions (10.5%), IC in 3 lesions (3.7%), ID in 6 lesions (7.3%), II in 19 lesions (23.2%), III in 30 lesions (36.7%), and IV in 15 lesions (18.3%). The mean stent length was 27.1+/-5.6 mm and the mean acute gain was 2.58+/-0.67 mm. No in-hospital MACE was observed. During the 30-day clinical follow-up, one patient developed acute myocardial infarction due to a subacute stent thrombosis. Forty two patients with 43 lesions underwent a 6-month follow-up coronary angiogram. The mean late loss at 6 months was 0.30+/-0.74 mm. The binary restenosis rate was 9.3% (4/43 lesion). The restenosed lesions were treated by balloon angioplasty in three lesions and by additional DES implantation in one lesion. CONCLUSION: Our results demonstrated that DES was a safe and very effective method for the treatment of ISR.

An Elevated Value of C-Reactive Protein is the Only Predictive Factor of Restenosis after Percutaneous Coronary Intervention

BACKGROUND: The current techniques for percutaneous coronary interventions (PCI) remain limited by restenosis. Recent studies have provided evidence of inflammation playing a role in the pathogenesis of cardiovascular disease. METHODS: Whether inflammatory markers are predictors of subsequent restenosis were prospectively tested in 272 consecutive patients with angiographically proven coronary artery disease. Patients having undergone PCI at Chonnam National University Hospital, between Sept. 1999 and Mar. 2001, were divided into two groups according to the occurrence of restenosis on a follow-up coronary angiogram: Group I were patients with restenosis (n=99, 59.5 +/- 10.8 years, M: F=77: 22) and Group II were those without restenosis (n=173, 58.8 +/- 10.2 years, M: F=131: 42). The IgG seropositivity, cytomegalovirus (CMV) titers, C. pneumoniae, H. pylori and levels of C-reactive protein (CRP) were compared between the two groups. RESULTS: There were no statistical differences in the seropositivity of the CMV IgG C. pneumoniae IgG and H. pylori IgG between the two groups (Groups I vs. II: 100 vs. 100%, 24.7 vs. 25.7% and 62.2 vs. 63.7%, respectively). Of the angiographic parameters, a low Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI 0 or I) was more common in Group I than Group II (p=0.038). The patients with an elevated CRP (> 0.5 mg/dL) were more common in Group I than Group II (57.6 vs. 36.4%, p=0.001), with the CRP values being higher in Group I than Group II (3.3 +/- 5.8 vs. 1.3 +/- 2.6 mg/dL, p=0.001). According to a multiple logistic regression analysis, the CRP was the only predictor of restenosis, with an odds ratio of 2.1169 (95% C.I. 1.2062-3.7154, p=0.009). CONCLUSION: The CRP value is the most important predictor of restenosis after PCI.

Patterns of Posterior Chest Leads (V7, V8, V9) ECG in Normal Adults

BACKGROUND AND OBJECTIVES: Recently many studies have confirmed positive identification of patients with posterior infarction through ST segment elevation in the electrocardiogram of posterior chest leads V7 through V9. However, the ECG patterns from posterior chest leads in normal adults have not been investigated, so this study was designed to examine such patterns. SUBJECTS AND METHODS: We studied 100 patients with normal conventional 12-lead ECG, normal physical examination and without any history of cardiovascular disease. Leads V7, V8 and V9 were recorded immediately after routine 12-lead ECG at the same horizontal level as that of V6 on the posterior axillary line (lead V7), the posterior scapular line (lead V8), and the left border of the spine (ead V9). RESULTS: The upright P waves in leads V7, V8 and V9 were 99%, 99% and 95% upright, respectively, while the other P waves were isoelectric and none were inverted. The T waves were all upright in leads V7 and V8, while in lead V9, 98% were upright, 2% were isoelectric and none were inverted. None of the subjects had a Q wave duration greater than 0.04 second in any of the 3 leads. At 0.08 second after the J point, only 2 subjects (2%) showed 0.5 to 1.0 mm ST segment elevation, but ST segment elevation was not greater than 1.0 mm in any of the subjects. CONCLUSION: P wave and T wave inversion were absent in all 3 leads. Q wave duration of greater than 0.04 second was also absent in all 3 leads. ST segment elevation was not greater than 1.0 mm in any of the subjects.

An elevated value of C-reactive protein is the only predictive factor of restenosis after percutaneous coronary intervention / 대한내과학회지

BACKGROUND: Current techniques of percutaneous coronary interventions (PCI) remain limited by the restenosis. Recent studies provide evidence that inflammation plays a role in the pathogenesis of cardiovascular disease. METHODS: We prospectively tested whether inflammatory markers are predictors of subsequent restenosis in 272 consecutive patients with angiographically proved coronary artery disease. The patients who underwent PCI at Chonnam National University Hospital between Sep. 1999 and Mar. 2001 were divided into two groups according to the occurrence of restenosis on follow-up coronary angiogram: patients with restenosis (Group I : n=99, 59.5 10.8 years, M : F=77:22) and patients without restenosis (Group II : n=173, 58.8 10.2 years, M : F=131:42). IgG seropositivity and titer of CMV, C. pneumoniae, H. pylori, levels of C-reactive protein (CRP) were compared between two groups. RESULTS: There were no statistical differences in the seropositivity of CMV IgG, C. pneumoniae IgG, H. pylori IgG between two groups (Group I vs. II : 100% vs. 100%, 24.7% vs. 25.7%, 62.2% vs. 63.7% in group I vs. II respectively). Among angiographic parameters, low TIMI flow (TIMI 0 or I) was more common in Group I than in Group II (p=0.038). The patients with elevated CRP (>0.5 mg/dL) were more common in Group I than those in Group II (57.6% vs. 36.4%, p=0.001) and the value of CRP was higher in Group I than in Group II (3.3+/-5.8 mg/dL vs. 1.3+/-2.6 mg/dL, p=0.001). According to multiple logistic regression analysis, CRP was the only predictor of restenosis with odd ratio of 2.1169 (95% C.I. 1.2062-3.7154, p=0.009). CONCLUSION: The value of CRP is the most important predictor of restenosis after PCI.

The Role of Fibrinogen, Lipoprotein (a) and C-Reactive Protein in Acute Thrombotic Occlusion after Percutaneous Coronary Intervention

BACKGROUND: Acute thrombotic occlusion after percutaneous coronary intervention (PCI) is a serious complication that provokes acute myocardial infarction, cardiac death or emergent bypass surgery. The role of fibrinogen, C-reactive protein (CRP) and lipoprotein (a) [Lp(a)] in the patients who developed acute thrombotic occlusion after PCI was investigated. METHODS: The patients with acute coronary syndrome who underwent PCI at Chonnam National University Hospital between Jan. 1999 and Jun. 2000 were divided into two groups according to the occurrence of acute thrombotic occlusion: patients with thrombotic occlusion after PCI (Group I; 62.3+/-8.8 years, M:F=19:8) and patients without thrombotic occlusion after PCI (Group II; 59.6+/-10.6 years, M:F=271:95). Clinical and angiographic characteristics, levels of fibrinogen, CRP and Lp(a) were compared between two groups. RESULTS: There were no significant differences in the level of fibrinogen between two groups. The patients with elevated CRP (>0.5mg/dL) were more common in Group I than those in Group II (88.9% vs. 42.3%, p=0.0001) and the value of CRP was higher in Group I than in Group II (4.97+/-5.18 mg/dL vs. 2.27+/-4.23 mg/dL, p=0.002). The patients with high Lp(a) (>30mg/dL) were more prevalent in Group I than those in Group II (44.4% vs 18.6%, p=0.001). There were no significant differences in the risk factors for coronary artery disease, except for diabetes mellitus (Group I : Group II, 40.7% : 16.9%, p=0.002). Thrombolysis in Myocardial Infarction (TIMI) flow of Group I was lower than in Group II (p=0.0001). Multiple regression analysis after the adjustment for age, sex and other cardiovascular risk factors, diabetes mellitus, low TIMI flow, high CRP and Lp(a) were independently associated with the occurrence of acute thrombotic occlusion (p=0.008, 0.0001, 0.031, 0.035, respectively). CONCLUSION:The elevated values of CRP and Lp(a), diabetes mellitus, and low TIMI flow are significant predictive factors for the acute thrombotic occlusion in patients with acute coronary syndrome after PCI.

The Rescue Use of A Platelet Glycoprotein IIb/IIIa Receptor Blocker (Abciximab; Reo-Pro ) in High-Risk Patients with Acute Myocardial Infarction Underwent Percutaneous Coronary Intervention

BACKGRUOND: Platelets are known to play a major role in the ischemic complications of percutaneous coronary intervention (PCI). Accordingly, we evaluated the effect of rescue use of a platelet glycoprotein IIb/IIIa receptor blocker (Abciximab; Reo-Pro ) in Korean patients with acute myocardial infarction (AMI) at high risk for the ischemic complications who underwent PCI. METHOD: Sixty eight patients (54 male, 59.1+/-9.96 years) treated by the rescue use of Reo-Pro out of 1,117 patients underwent PCI at Chonnam National University Hospital from Mar 1999 to Feb 2000. All of target lesions were thrombus-containing lesions in patients with AMI. The primary end points consisted of any of the followings : cardiac death, nonfatal MI, repeated revascularization. The number of end-point events were tabulated at 6 months after PCI. RESULTS: The primary success rate was 92.6% (63/68). At primary end points, there were 5 cases (7.3%), composed of 2 deaths (2.9%), 1 MI, 2 repeated revascularization (2.9%). There was no major bleeding complication after PCI. At secondary end point, there were 23 cases (34.9%) including primary end point, composed of 3 deaths (4.4%), 1 MI and 19 revascularization (28.0%). CONCLUSION: The rescue Reo-Pro can be used safely and effectively in high-risk Korean patients with AMI.

The Relationship of Infection and Inflammation with Coronary Restenosis after Percutaneous Coronary Interventions

BACKGROUND AND OBJECTIVES: Possible correlations between the serologic status concerning Cytomegalovirus(CMV), Chlamydia pneumoniae (CP), Helicobacter pylori(HP), their related markers of C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), and the restenosis(RS) in patients underwent percutaneous coronary intervention(PCI) were analyzed. Materials and METHODS: The 142 patients(58.010.9 year-old, M;F=116:26) with 189 coronary lesions, who underwent follow-up angiography after PCI, were evaluated. RESULTS: The overall RS rate was 47.1%(89/189), and the RS rate according to clinical diagnosis was 50.6% in acute myocardial infarction(MI), 41.8% in unstable angina(UA), 6.3% in stable angina(SA), and 1.3% in old MI. The values of RS rate in acute MI and UA were higher than those of old MI and SA(p=0.02). Thrombolysis In Myocardial Infarction(TIMI) flow was significantly lower in group with RS than without RS(p=0.039). Seropositivities of CMV, CP, HP were not different between groups with and without RS. Titers of CMV and HP were not different between two groups. Positivity of CRP was 56.3% in group with RS and 30.2% in group without RS(p=0.005). Titers of ESR and CRP were higher in group with RS than without RS(20.322.4 mm/hr, 2.24.5 mg/dL vs. 11.811.6 mm/hr, 0.70.8 mg/dL, p=0.007, p=0.010 respectively). CONCLUSION: RS rate after PCI is higher in patients with acute coronary syndrome and low TIMI flow. Inflammatory markers, such as CRP and ESR, might be associated with the RS after PCI.

The Clinical Effects of Tranilast on Restenosis after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND AND OBJECTIVES: Tranilast is an anti-allergic drug that suppresses the release of cytokines, such as platelet-derived growth factor, transforming growth factor-beta and interleukin-1beta. It has recently become known to be effective in the prevention of restenosis following PTCA (percutaneous transluminal coronary angioplasty). SUBJECTS AND METHODS: One hundred forty two consecutive patients with angina who underwent PTCA between Jan 1999 and Jul 2000 at Chonnam National University Hospital were analyzed prospectively. Thirty patients (Tranilast group:60.8+/-7.7 years, M:F=22:8, 41 lesions) out of 48 who received 300 mg tranilast for 3 months following PTCA and who underwent follow-up CAG (coronary angiogram), were compared with 61 patients (Control group:58.1+/-11.0 years, M:F=52:9, 82 lesions) out of 94, 94 who did not receive tranilast but did undergo follow-up CAG. RESULTS: The restenosis rate per lesion was significantly lower in the Tranilast group than in the Control group on the 6-month follow-up CAG (Tranilast vs. Control group:19.5% vs. 40.2%, p=0.021). The minimal luminal diameter was significantly larger in the Tranilast group as compared to the Control group (1.99+/-0.76 vs. 1.50+/-0.83 mm p=0.002). One patient of the Tranilast group suffered from liver dysfunction and stopped medication. CONCLUSION: The oral administration of tranilast is safe and effective in the prevention of restenosis following PTCA in patients with angina.

A Study of Plasma Apolipoprotein A-1 and Apolipoprotein B Levels in Patients with Coronary Artery Disease

BACKGROUND: It is known that dyslipidemia plays and important role in atherogenesis and progression for the disease. Recently it was reported that apolipoprotein levels are important in athcrogenesis. In Korean patients the study of the apolipoprotein levels as for the risk factor for atherogenesis is still needed. Subjects and METHODS: The 107 patients who underwent coronary angiography to differentiate chest pain syndrome were subjected to this study. Thirty-two patients who had no significant coronary artery disease served as a control group and 75 patients who had one or more coronary stenoses more than 50% narrowing by luminal diameter served as the coronary artery disease(CAD) group. Plasma levels of total cholesterol, triglycerides, high density lipoprotein cholestero(HDL-C), apolipoprotein A-1(Apo- A1) and apolipoprotein B(Apo B) were measured from venous blood after overnight fastion, and the results were compared between the groups. RESULTS: The male gender and smoking habits were more prevalent in the CAD group. Total cholesterol levels were significantly higher in the CAD group but the HDL-C level was not significantly different in two groups though the mean level of the HDL-C was some lower in the CAD group. The Apo A-1 level was lowere in the CAD group while the Apo B level was higher in teh CAD group compared to those of the control, Apo B / Apo A-1 ratio much more distinctly discriminated the two groups. CONCLUSION: Theses results suggest that the plasma Apo-A-1, Apo B levels and the ratio of Apo B / Apo A-1 can be used for risk statification of CAD.