A long stent is the only predictive factor for coronary stent restenosis / 대한내과학회지

BACKGROUND: Coronary stenting is one of the most effective methods of percutaneous coronary interventions (PCI) in the treatment of intimal dissection and prevention of restenosis after balloon angioplasty. However, coronary stent restenosis still remains a major clinical limitation. METHODS: Three hundreds seventy three patients who underwent coronary stent implantations and follow-up coronary aniograms at Chonnam National University Hospital between June 1996 and December 1999, were divided into two groups: 123 patients with restenosis (Group A: 98 male, 25 female, 58.5+/-9.4 year-old) and 240 patients without restenosis (Group B: 193 male, 47 female). RESULTS: The prevalence of clinical diagnosis and risk factors for the atherosclerosis were not different between two groups. The indications for stenting and stent types, reference vessel diameter and minimal luminal diameter before stenting were not different. However, stent length was 23.4+/-7.57 mm in Group A and 20.8+/-6.58 mm in Group B, which were longer in Group A than in Group B (p=001). By multiple logistic regression analysis for the independent predictive factors for stent restenosis, the long stent more than 25mm in length was the only significant predictive factor after correction according to age, sex, risk factor, lipid profiles (OR=2.590, 95% C.I.=1.40-4.78). CONCLUSION: The long coronary stent more than 25 mm in length is a predictive factor of restenosis after coronary stenting.

The Long-term Clinical Outcomes after Rescue Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: A rescue percutaneous coronary intervention (PCI) has been used to treat the patients after failed thrombolysis in acute myocardial infarction. However, short- and long-term benefits of rescue PCI has not been known exactly. The goal of this study was to examine the clinical and angiographic outcomes, success rate of the procedure, and long-term survival rate after rescue PCI. MATERIALS AND METHODS: Clinical and angiographic outcomes of 31 patients (Group I; 59.7+/-11.4 years, 80.6% male), who underwent rescue PCI were compared with those of 177 patients (Group II; 59.7+/-9.7 years, 79.7% male), primary PCI at Chonnam National University Hospital between January 1997 and December 1999. RESULTS: There were no significant differences in the risk factors for coronary artery diseases except for smoking (Group I; 24/31, 77.4% vs. Group II; 76/177, 42.9%, P<0.05). The incidence of cardiogenic shock was higher in Group I than in Group II (Group I; 7/31, 22.6% vs. Group II; 11/177, 6.2%, P<0.05). The coronary angiographic findings were not different between two groups. Thrombolysis in Myocardial Infarction flow of Group I was lower than in Group II (Group I; 1.14+/-0.93 vs. Group II; 1.61+/-1.14, P<0.05). Primary success rate was 93.6% (29/31) in Group I and 94.9% (168/177) in Group II (P<0.05). Baseline ejection fraction was lower in Group I than in Group II (Group I; 44.2+/-8.9% vs. Group II; 50.8+/-11.7, P<0.05), which improved in both groups (Group I; 51.7+/-7.9% vs. Group II; 60.7+/-13.4%, P<0.05) at six months after the procedures. The survival rate of Group I was 93.5%, 93.5% and 90.3% and that of Group II was 94.5%, 93.7% and 91% at 1 month, 6 and 12 months, respectively. CONCLUSION: Rescue PCI was associated with the risk factor of smoking and the high incidence of cardiogenic shock. The success rate of rescue PCI was comparable with primary PCI and left ventricular function was improved after rescue PCI on long-term clinical follow-up with relatively high survival rate.