Background The long-term safety and efficacy of drug-eluting stents （DES） versus bare metal stents （BMS） are unclear and controversial issues in patients with acute ST-elevation myocardial infarction （STEMI） und...Background The long-term safety and efficacy of drug-eluting stents （DES） versus bare metal stents （BMS） are unclear and controversial issues in patients with acute ST-elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation. Methods A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES （n=83） or BMS （n=108） implantation in the infarction related artery according to physician＇s discretion. The primary outcome was the occurrence of major adverse cardiac events （MACE）, which was defined as a composite of death, myocardial infarction （MI）, target vessel revascularization （TVR） and stent thrombosis. The difference of MACE was observed between DES and BMS groups. Results The clinical follow-up duration was 3 years （（41.7±16.1） months）. MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction （LVEF） was an independent predictor for MACE in the follow-up period （P=0.0301）. There was no significant difference in all-cause mortality （3.61% vs. 7.41%, P=0.2647）, the incidence of myocardial infarction （0 vs. 0.93%, P=-0.379） and stent thrombosis （1.20% vs. 1.85%, P=0.727） between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group （4.82% vs. 14.81%, P=0.0253）. The rate of TVR was also lower in the DES group （0 vs. 5.56%, P=0.029）. In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents （SES, n=73） and paclitaxel-eluting stents （PES, n=10） subgroups （2.74% vs. 20.00%, P 〉0.05）. Conclusions This finding suggested that drug-eluting stents significantly reduced the need for revascularization in pa展开更多
Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons a...Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons and stents are always necessary to achieve the best results from percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the principles of bare metal stents (BMS) by local drug release to inhibit neointimal growth. DES reduced the incidence of in-stent restenosis. These benefits and lower costs compared to surgical treatment make the DES an attractive alternative for the treatment of coronary artery disease. Different components of DES which include the polymers, drugs and the stents underwent progressive evolution, and these led to development of new generations of DES with variable types of drugs and polymers to fully absorbable stents. The concern of stent thrombosis still an issue and dual antiplatlets therapy (DAPT) is mandatory for variable time ranging from one month to one year. This article discusses the main available clinical trials in the developments of BMS, DES and the comparison between both with a prospective look at future technologies in the field, in addition to reviewing the current guideline in the uses of DAPT after PCI.展开更多
Background Recent studies have showed that the fine mesh stents are associated with a significant reduction in both clinical and angiographic re-stenosis of the coronary arteries. To maintain a very satisfactory radio...Background Recent studies have showed that the fine mesh stents are associated with a significant reduction in both clinical and angiographic re-stenosis of the coronary arteries. To maintain a very satisfactory radio-opacity using the stents, Guidant of the USA has designed a new type of bare metal stents （BMS）-Multi-link （ML） Vision / ML MiniVision stents. The clinical outcomes of Asian patients with coronary artery disease （CAD） after implanting the Multi-link Vision or MiniVision stent were investigated in this study. Methods An observational, prospective, multi-center, non-randomized post marketing registry was conducted to demonstrate the efficacy of the BMS- ML Vision / ML MiniVision stents. The primary end point of the registry was clinical target lesion revascularization （TLR） at a 6-month follow-up. The major secondary end points included the rate of major adverse cardiac events （MACE） and serious adverse events （SAE） in hospital and at 6 months; and the rate of clinical TLR as a function of the type of angina. A total of 429 Asian people with 449 lesions from 14 centers were selected for this study, The average reference diameter of the lesions was （3.0±0.5） mm, and the mean length was （15.7±5.0） mm. Results The successful rate of the procedure was 99.3%. Twenty-five percent of the lesions were treated by direct stenting without pre-dilation. Eighty-six percent of the lesions were implanted with ML Vision stent. After the 6-month follow-up, the rate of clinical TLR was 1.4%. The MACE, SAE and target vessel revascularization （TVR） were 6.8%, 3.5% and 1.4% respectively. Conclusion The current registry showed the excellent 6-month clinical outcomes of ML Vision/ML MiniVision stents in Asian patients with CAD.展开更多
文摘Background The long-term safety and efficacy of drug-eluting stents （DES） versus bare metal stents （BMS） are unclear and controversial issues in patients with acute ST-elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation. Methods A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES （n=83） or BMS （n=108） implantation in the infarction related artery according to physician＇s discretion. The primary outcome was the occurrence of major adverse cardiac events （MACE）, which was defined as a composite of death, myocardial infarction （MI）, target vessel revascularization （TVR） and stent thrombosis. The difference of MACE was observed between DES and BMS groups. Results The clinical follow-up duration was 3 years （（41.7±16.1） months）. MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction （LVEF） was an independent predictor for MACE in the follow-up period （P=0.0301）. There was no significant difference in all-cause mortality （3.61% vs. 7.41%, P=0.2647）, the incidence of myocardial infarction （0 vs. 0.93%, P=-0.379） and stent thrombosis （1.20% vs. 1.85%, P=0.727） between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group （4.82% vs. 14.81%, P=0.0253）. The rate of TVR was also lower in the DES group （0 vs. 5.56%, P=0.029）. In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents （SES, n=73） and paclitaxel-eluting stents （PES, n=10） subgroups （2.74% vs. 20.00%, P 〉0.05）. Conclusions This finding suggested that drug-eluting stents significantly reduced the need for revascularization in pa
文摘Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons and stents are always necessary to achieve the best results from percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the principles of bare metal stents (BMS) by local drug release to inhibit neointimal growth. DES reduced the incidence of in-stent restenosis. These benefits and lower costs compared to surgical treatment make the DES an attractive alternative for the treatment of coronary artery disease. Different components of DES which include the polymers, drugs and the stents underwent progressive evolution, and these led to development of new generations of DES with variable types of drugs and polymers to fully absorbable stents. The concern of stent thrombosis still an issue and dual antiplatlets therapy (DAPT) is mandatory for variable time ranging from one month to one year. This article discusses the main available clinical trials in the developments of BMS, DES and the comparison between both with a prospective look at future technologies in the field, in addition to reviewing the current guideline in the uses of DAPT after PCI.
文摘Background Recent studies have showed that the fine mesh stents are associated with a significant reduction in both clinical and angiographic re-stenosis of the coronary arteries. To maintain a very satisfactory radio-opacity using the stents, Guidant of the USA has designed a new type of bare metal stents （BMS）-Multi-link （ML） Vision / ML MiniVision stents. The clinical outcomes of Asian patients with coronary artery disease （CAD） after implanting the Multi-link Vision or MiniVision stent were investigated in this study. Methods An observational, prospective, multi-center, non-randomized post marketing registry was conducted to demonstrate the efficacy of the BMS- ML Vision / ML MiniVision stents. The primary end point of the registry was clinical target lesion revascularization （TLR） at a 6-month follow-up. The major secondary end points included the rate of major adverse cardiac events （MACE） and serious adverse events （SAE） in hospital and at 6 months; and the rate of clinical TLR as a function of the type of angina. A total of 429 Asian people with 449 lesions from 14 centers were selected for this study, The average reference diameter of the lesions was （3.0±0.5） mm, and the mean length was （15.7±5.0） mm. Results The successful rate of the procedure was 99.3%. Twenty-five percent of the lesions were treated by direct stenting without pre-dilation. Eighty-six percent of the lesions were implanted with ML Vision stent. After the 6-month follow-up, the rate of clinical TLR was 1.4%. The MACE, SAE and target vessel revascularization （TVR） were 6.8%, 3.5% and 1.4% respectively. Conclusion The current registry showed the excellent 6-month clinical outcomes of ML Vision/ML MiniVision stents in Asian patients with CAD.
