Long-term safety and efficacy are observed after implantation of Zotarolimus-Eluting stent in real-world clinical practice.

AIMS: Zotarolimus-eluting stents (ZESs) have been shown to be safe and effective in randomised trials. We sought to report the clinical outcomes after implantation of ZES in real-world clinical practice. METHODS AND RESULTS: ZES have been approved for clinical use in Singapore since April 2005. Until December 31, 2007, a total of 219 patients had undergone implantation of ZES. After excluding 11 foreign patients with whom contact was lost, 208 patients (246 lesions, 305 stents) formed the study cohort. A high-proportion of diabetic patients (n=90, 43.3%) was included. Recommended dual antiplatelet therapy was at least 3 months (n=147) for patients treated before or 12 months (n=61) after January 2007. As of January 2008, the median follow-up duration was 19 months (range: 1 to 33 months). There were 10 (4.8%) deaths, including 7 (3.4%) cardiac deaths. Myocardial infarction occurred in 11 (5.3%) patients. The numbers of patients requiring target vessel revascularisation and target lesion revascularisation were 10 (4.8%) and 5 (2.4%) respectively. Using the ARC definition, there were two cases of definite stent thrombosis on days 7 and 17, and one case of probable stent thrombosis on day 15. CONCLUSIONS: In this real-world clinical experience, ZES was associated with a low incidence of adverse cardiac events at a medium follow-up of one and half years.

Inverse relation between diastolic blood pressure and long-term outcomes in patients undergoing pharmacoinvasive therapy for myocardial infarction: the J-shaped relation in the contemporary era of revascularisation.

OBJECTIVE: In the thrombolytic era, it was reported that in the presence of significant coronary stenosis, lowering diastolic blood pressure (DBP) below a critical threshold would result in a paradoxical increase in the occurrence of myocardial infarction (MI). We sought to re-evaluate this J-shaped relation in the era of pharmacoinvasive therapy. METHODS: A total of 182 patients who underwent early (<1 week, mean 2.3 days) coronary angioplasty after thrombolysis were analysed. RESULTS: Thrombolytic agents (streptokinase in 60%, tissue plasminogen activator in 40%) were administered in an average door-to-needle time of 66 min (<=30 min in 43 [24%] patients). A thrombolysis in myocardial infarction (TIMI) 3 flow was achieved in 56% of patients after thrombolysis, and it was enhanced to 92% after angioplasty. During an average follow-up period of 26 +/-13 months, the adverse event (death, re-MI, target vessel revascularisation or stroke) rate was 21%. Older age, low systolic blood pressure and DBP, fast heart rate, high creatine kinase, hypercholesterolaemia, thrombus-laden lesion, baseline TIMI 0-2 flow were associated with higher occurrence of adverse events. After adjusting for the differing clinical and procedural factors, low DBP (odds ratio 1.10, 95% confidence interval 1.01-1.20, P = 0.041), fast heart rate (odds ratio 1.08, 95% confidence interval 1.02-1.14, P = 0.008) and anterior MI (odds ratio 18.98, 95% confidence interval 2.13-169.19, P = 0.008) were all independent predictors of long-term adverse rate occurrence. CONCLUSIONS: A low DBP is an independent predictor of long-term adverse event rates in patients undergoing routine early coronary angioplasty after thrombolysis. This suggests that excessive lowering of DBP may not be desirable before complete revascularisation.