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Objective To observe the efficacy and safety of 150 mg clopidogrel and triple antiplatelet in acute anterior myocardial infarction ( AMI) patients undergoing percutaneous coronary intervention ( PCI).Methods Totally 50 patients who had been diagnosed as acute anterior myocardial infarction and prepared to PCI treatment were randomly divided into two groups:150 mg clopidogrel group ( asprin 100 mg/d qd+clopidogrel 150 mg/d qd) and triple antiplatelet group ( cilostazol 100 mg bid+asprin 100 mg/d qd+clopidogrel 75 mg/d qd).The coronary lession through CAG, incidence of major cardiovascular events and safety in 6 months were observed and assessed.ResuIts There was no significant difference in level of target lesion diameter between two groups after PCI instantly (2.75 ±0.29 mm vs.2.69 ±0.31 mm).There were no significant differences of late lumen loss (LLL) and target lesion revascularization (TLR) between triple antiplatelet group and 150 mg clopidogrel group (0.22 ±0.46 mm vs.0.38 ±0.65 mm; 8%vs.24%) , but the two indexes were improved in a certain extent.There were no significant differences in hemorrhage and major adverse cardiovascular events ( MACE) between two groups.ConcIusion The triple antiplatelet therapy could reduce the late lumen loss and target lesion revascularization, and not increase hemorrhage and adverse cardiovascular events.
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Objective Compare the efifcacy and safety of drug eluting stent (DES) for treatment of in stent restenosis (ISR) and coronary de novo lesions. Methods Patients treated with DES for ISR and de novo lesions in Beijing Anzhen Hospital between October 2008 and December 2011 were followed up for 1 year. All lesions were divided into ISR and de novo group. Major adverse cardiovascular events (MACE) including all-cause death, myocardial infarction (MI) and clinical target lesion revascularization (TLR) were the primary endpoints. Results The study population consisted of 204 patients in the ISR group and 494 patients in the de novo group. Baseline clinical and angiographic parameters were comparable between the two groups. The rate of diabetic was higher in the ISR group than that in the de novo group (36.6%to 27.1%, P < 0.05). The diameter of coronary artery was smaller in the ISR group than that in the de novo group (2.72±0.36 to 3.08±0.54, P<0.01). The rate of TLR in the ISR group was higher than that in the de novo group (10.7%to 17.2%, P<0.05;14.2%to 21.1%, P<0.05),contributing to higher MACE in ISR group. Conclusions DES implantation is safe and effective for treatment of ISR lesions, but the rate of TLR is higher compared to treatment of de novo lesions.
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Objective To study the feasibility of using fractional flow reserve (FFR) to guide whether to perform coronary revascularization of non-culprit moderate stenosis in patients with unstable angina and estimate their clinical prognosis. Methods This study enrolled unstable angina patients with multivessel disease. First successful stenting of the culprit artery, then the other non-culprit moderate coronary stenosis were randomized into PCI guided by angiography or guided by FFR measurements. Death from any cause, nonfatal myocardial infarction, unplanned hospitalization leading to urgent revascularization and clinical manifestations with angina were followed during the first year. Results 71 patients were included, among them 35 patiens were randomly assigned to angiography-guided PCI and 36 patients to FFR-guided PCI. In FFR-guided PCI group, FFR was successfully measured in all of non-culprit moderate coronary stenosis. In 23 stenosis, the FFR was greater than 0.80, and stents were not placed in these stenosis. In 13 stenosis with FFR<0.8, stent were inplant and FFR was raised≥0.95 after stenting. The percentage of patients who had a primary end-point event was higher in the angiography-guided PCI group than the FFR-guided PCI group (P<0.05). Neither the rate of mortelity from any cause nor the rate of non-fatal myocardial infarction had significant difference between the 2 groups. Related to the target vessels rates of nonfatal myocardial infarction (5.6%vs. 28.6%) and target lesion revascularization (5.6%vs. 31.4%) were statistically different (P<0.01 and P<0.05, respectively). Conclusions In patients with unstable angina, it is safe to use FFR values to guide decisions on the revascularization of angiographically moderate non-culprit stenosis. Routine measurement of FFR in addition to angiographic guidance, as compared with PCI guided by angiography alone, results in a significant reduction in major adverse events at 1 year, particularly in urgent revascularization, and clinical manifestations with angina get better.
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BACKGROUND AND OBJECTIVES: A noninvasive test with a high predictive value for detecting restenosis is needed to reduce the need for unnecessary coronary angiography. Recently, dobutamine stress echocardiography(DSE) has been shown to be highly sensitive, specific and accurate for the detection of coronary artery disease. No prior study, however, has evaluated its ability to detect restenosis after intracoronary stenting. The aim of this study was to determine the feasibility of DSE for detecting restenosis after intracoronary stenting. METHODS: To determine the feasibility of DSE for detecting restenosis after intracoronary stenting, the results of follow-up coronary angiography and DSE and treadmill exercise test(TMET) were examined in 36 patients(age, 61+/-6 yeas; 22 men) at least 4 months after angiographically successful intracoronary stenting. The DSE and TMET were performed at day 1. Dobutamine was infused with starting at a dose of 10 microgram/kg/min for 3 minutes, and increasing by 10microgram/kg/min every 3 minutes to a maximum of 40microgram/kg/min. In patients not achieving 85% of their age-predicted maximal heart rate, atropine (0.25mg intravenously, repeated up to maximum of 1mg if necessary) was added while the dobutamine infusion was continued. Positive findings for restenosis were defined as new or worsened wall motion abnormality at a previously dilated vascular territories. The coronary angiography was performed at day 2. Restenosis was defined as > or =50% lumen narrowing, determined by quantitative coronary angiography. RESULTS: Restenosis was angiographically demonstrated in 14 lesions(34.1%) of 41 lesions. The sensitivity and specificity of DSE for detecting restenosis was 50%(7/14) and 96.2%(26/27), and positive predictive value was 87.5%(7/8), negative predictive value was 78.8%(26/33), respectively. When restenosis was defined as > or =60% lumen narrowing, the sensitivity and specificity of DSE for detecting restenosis was 66.7%(6/9) and 96.9%(31/32), respectively. The target lesion revascularization rate(TLR) was 17%(7/41). The sensitivity of DSE for determining TLR was 85.7% (6/7) and specificity was 97.0%(33/34). CONCLUSION: It is concluded that DSE has a moderate sensitivity and high specificity for detecting restenosis after intracoronary stenting. DSE may be a useful diagnostic modality for determining target lesion revascularization of restenotic lesion but further studies are needed.