Predictive factor of the third coronary stent restenosis / 대한내과학회지

BACKGROUND: Percutaneous coronary intervention (PCI) has been established as one of the effective therapeutic methods in the treatment of ischemic heart disease. A coronary artery stent is the most promising device in PCI, however in-stent restenosis (ISR) remains a major problem to be overcome. METHODS: Follow-up coronary angiograms (CAG) three times after stenting were performed in 107 out of 3,816 stented patients at Chonnam National University Hospital between August 1992 and July 2004. The patients were divided into four groups: forty eight patients (Group I: 58.7+/-9.5 years, 35 Males) had no incident ISR on three follow-up CAG. Fourteen patients had three times of ISR and underwent four PCIs (Group II : 54.5+/-9.51 years, 12 Males), 15 had two times of ISR and underwent three PCIs (Group III : 53.9+/-5.9 years, 11 males), 30 had one time of ISR and underwent two PCIs (Group IV : 59.6+/-9.5 years, 27 males). Each group was analysed according to clinical characteristics, coronary angiographic findings, and therapeutic modalities for ISR. RESULTS: There was no differences in clinical diagnosis, lesion location, multi-vessel lesion and TIMI flow. Risk factors for atherosclerosis were not different except for diabetes mellitus. The incidence of diabetes mellitus was more common in Group II than in Group I (Group I: 22%, Group II: 57%, Group III: 46%, Group IV: 20%, Group I vs. Group II: p =0.023). Stent length and diameter were not different among four groups. CONCLUSION: The only predictor of recurrent coronary stent restenosis more than three times is diabetes mellitus.

Inhibitory Effect of Rapamycin on Corneal Neovascularization induced by Angiogenin in Rabbits

PURPOSE: The purpose of this study was to determine whether immunosuppressant, rapamycin could inhibit corneal angiogenesis induced by angiogenin and to evalutate its role by micropocket assay. METHODS: The rabbit's eye was implanted intrastromally into the superior cornea with pellet for the control group, pellet containing of angiogenin for the angiogenin group, and pellet containing of angiogenin and rapamycin for the angiogenin+rapamycin group. Biomicrographically, corneal angiogenesis was evaluated for 14 days after pellet implantation, based on the number and the length of new vessels. The neovascularized cornea also was examined histologically. RESULTS: We could observe that the angiogenin inducing corneal angiogenesis was inhibited by rapamycin. The score of neovascularization was significantly decreased in the angiogenin+rapamycin group than in the angiogenin group at 3, 7 and 10 days after pellet implantation (p<0.05). Histologically, the cornea of angiogenin+rapamycin group also showed much less new vessels than that of angiogenin group, in which inflammatory cells and edema was observed. CONCLUSIONS: Rapamycin appears to inhibit angiogenin induced angiogenesis in a rabbit corneal micropocket assay and may have therapeutic potential as an antiangiogenic agent.

The Long-Term Clinical Results of a Platelet Glycoprotein IIb/IIIa Receptor Blocker (Abciximab : ReoPro(R)) Coated Stent in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The inhibition of coronary restenosis with an Abciximab (ReoPro(R))-coated stent has previously been reported by us. This study investigated the clinical outcomes of patients with acute myocardial infarction (AMI) treated with ReoPro-coated stents. SUBJECTS AND METHOD: A prospective randomized trial was conducted to compare two types of stent for the revascularization in 63 patients [Group I (ReoPro(r)-coated stent):n=32, 53.7+/-11.8 years, 27 male, and Group II (control stent):n=31, 55.4+/-12.1 years, 27 male] with AMI. The primary effective end points were major adverse coronary events (MACE):cardiac death, acute myocardial infarction, target lesion revascularization (TLR), in-stent restenosis and late lumen loss at the 1 year clinical and angiographic follow-ups. RESULTS: Baseline clinical characteristics and diameters of stenosis and the minimal luminal diameters were no different between the two groups. There was one myocardial infarction and revascularization during the hospital stay in group II. Follow-up coronary angiograms were performed in 71.9 (23/32) and 77.4% (24/31) of groups I and II, respectively. The diameter of stenosis and late loss were significantly lower in group I than group II (19.4+/-5.1 vs. 34.8+/-5.9%, p=0.013;and 0.39+/-0.26 vs. 0.89+/-0.45 mm;p=0.008, respectively). However, the restenosis rates were no different between the two groups (21.7 vs. 37.5%, p=0.341). One year clinical follow-ups were possible in 98.4% (62/63), and there were two AMI found in group II, but none in group I. The TLR rates and total MACE of group I were relatively lower compared with group II [12.9 (4/31) vs. 29.0% (9/31);p=0.122 and 12.9 (4/31) vs. 35.5% (11/31), p=0.038, respectively]. CONCLUSION: The ReoPro(R)-coated stent was safe, with no stent thrombosis, and effective in patients with AMI.