Mid-term angiographic benefit of sirolimus-eluting stents compared with paclitaxel-eluting stents in patients with acute myocardial infarction

Choi, Cheol Ung,Rha, Seung-Woon,Chen, Kang-Yin,Jin, Zhe,Minami, Yoshiyasu,Shin, Seung Yong,Na, Jin Oh,Suh, Soon Yong,Lim, Hong Euy,Kim, Jin Won,Kim, Eung Ju,Park, Chang Gyu,Seo, Hong Seog,Oh, Dong Joo Elsevier 2009 Journal of cardiology Vol.54 No.1

<P><B>Summary</B></P><P><B>Background</B></P><P>We compared angiographic and clinical outcomes among different drug-eluting stents (DESs) in Korean acute myocardial infarction (AMI) patients.</P><P><B>Methods</B></P><P>A total of 109 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) with either sirolimus-eluting (SES, <I>n</I>=56 pts) or paclitaxel-eluting stents (PES, <I>n</I>=53 pts) were enrolled from August 2004 to December 2006. The angiographic outcomes at 6 months and clinical outcomes at 1 year were compared between the two groups.</P><P><B>Results</B></P><P>Baseline clinical and procedural characteristics were similar between the two groups. At 6 months, the rate of binary restenosis was 17.0% in the PES group compared with 3.6% in the SES group (<I>p</I>=0.026). Percent restenosis was 24.9±28.6% in the PES group compared with 11.2±17.6% in the SES group (<I>p</I>=0.004). Length of restenosis segment was 3.21±9.02mm in the PES group compared with 0.89±2.38mm in the SES group (<I>p</I>=0.048). Late loss was 0.73±0.89mm in the PES group compared with 0.28±0.37mm in the SES group (<I>p</I>=0.001). However, there were no differences in clinical outcomes at 1 year including mortality, myocardial infarction, repeat PCI, and major cardiac adverse events between two groups.</P><P><B>Conclusion</B></P><P>SES implantation in patients with AMI was associated with reduction in angiographic restenosis at 6 months compared with PES, however, these angiographic benefits were not translated into better clinical outcomes in real world clinical practice.</P>

Impact of Heterogeneous Overlapping Drug-Eluting Stents on the Arterial Responses of Rabbit Iliac Arteries: A Comparison With Overlapping Bare Metal Stents

나승운,Kang-Yin Chen,오동주,Yong-Jian Li,Zhe Jin,Kanhaiya Lal Poddar,Sureshkumar Ramasamy,Yoshiyasu Minami,Amro Elnagar,최병걸,Sang Pyo Hong,Byoung Won Cheon,Sang Ki Moon,Sung Il Im,Sun Won Kim,나진오,홍영준,임홍의,김진원 대한심장학회 2012 Korean Circulation Journal Vol.42 No.6

Background and Objectives: Although the use of heterogeneous overlapping drug-eluting stents (DES) is not uncommon in clinical practice, whether the implantation sequences of heterogeneous DES will influence the endothelialization or arterial responses differently remains unclear. Materials and Methods: Twenty-one rabbits were randomized to receive overlapping stents in the iliac artery for 3 months {distal siroli-mus-eluting stent (SES, Cypher TM )+proximal paclitaxel-eluting stent (PES, Taxus TM ) (C+T, n=7), distal Taxus+proximal Cypher (T+C, n=7) and bare metal stent (BMS)+BMS (B+B, n=7)}. Endothelial function was evaluated by the acetylcholine provocation test during follow-up an-giography. Histopathological changes in proximal, overlapped, and distal stented segments were evaluated. Results: Although the overall angiographic outcomes were comparable, late loss (mm) in the distal stented segment was higher in the B+B (0.39±0.07) and C+T (0.40±0.20) than that in the T+C (0.06±0.02) group (p<0.001). The incidence of acetylcholine-induced spasm was higher in the DES groups compared with BMS, regardless of the implantation sequences (85.7% in C+T vs. 14.3% in B+B vs. 71.4% in T+C,p=0.017). Notably, only the distal Cypher implantation group (C+T) had three cases of stent fracture. A histopathological analysis showed that despite similar arterial injury scores, Taxus and Cypher stents had higher inflammatory reactions at the overlapped and distal segments compared with those of BMS. Conclusion: Despite similar arterial injury, higher inflammatory reactions were observed in overlapping DES segments regardless of the im -plantation sequence compared with that of BMS. Moreover, DES was associated with impaired endothelial function on the adjacent non-stented segments.

Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Chen, Kang-Yin,Rha, Seung-Woon,Li, Yong-Jian,Poddar, Kanhaiya L,Jin, Zhe,Minami, Yoshiyasu,Wang, Lin,Kim, Eung Ju,Park, Chang Gyu,Seo, Hong Seog,Oh, Dong Joo,Jeong, Myung Ho,Ahn, Young Keun,Hong, Taek American Heart Association, etc.] 2009 CIRCULATION - Vol.119 No.25

<P>BACKGROUND: Whether triple antiplatelet therapy is superior or similar to dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention in the era of drug-eluting stents remains unclear. METHODS AND RESULTS: A total of 4203 ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention with drug-eluting stents were analyzed retrospectively in the Korean Acute Myocardial Infarction Registry (KAMIR). They received either dual (aspirin plus clopidogrel; dual group; n=2569) or triple (aspirin plus clopidogrel plus cilostazol; triple group; n=1634) antiplatelet therapy. The triple group received additional cilostazol at least for 1 month. Various major adverse cardiac events at 8 months were compared between these 2 groups. Compared with the dual group, the triple group had a similar incidence of major bleeding events but a significantly lower incidence of in-hospital mortality. Clinical outcomes at 8 months showed that the triple group had significantly lower incidences of cardiac death (adjusted odds ratio, 0.52; 95% confidence interval, 0.32 to 0.84; P=0.007), total death (adjusted odds ratio, 0.60; 95% confidence interval, 0.41 to 0.89; P=0.010), and total major adverse cardiac events (adjusted odds ratio, 0.74; 95% confidence interval, 0.58 to 0.95; P=0.019) than the dual group. Subgroup analysis showed that older (>65 years old), female, and diabetic patients got more benefits from triple antiplatelet therapy than their counterparts who received dual antiplatelet therapy. CONCLUSIONS: Triple antiplatelet therapy seems to be superior to dual antiplatelet therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stents. These results may provide the rationale for the use of triple antiplatelet therapy in these patients.</P>

Peripheral arterial disease is associated with coronary artery spasm as assessed by an intracoronary acetylcholine provocation test

Chen, Kang-Yin,Rha, Seung-Woon,Li, Yong-Jian,Poddar, Kanhaiya L,Jin, Zhe,Minami, Yoshiyasu,Wang, Lin,Li, Guang-Ping,Saito, Shigeru,Park, Jae-Hyoung,Na, Jin-Oh,Choi, Cheol Ung,Lim, Hong-Euy,Kim, Jin-Wo Blackwell Publishing Ltd 2009 Clinical and Experimental Pharmacology & Physiolog Vol.36 No.11

<P>Summary</P><P>1. Both peripheral arterial disease (PAD) and coronary artery spasm (CAS) are associated with endothelial dysfunction. Thus, a higher incidence of CAS may be expected in patients with PAD. In the present study, we evaluated the incidence and characteristics of CAS in patients with PAD.</P><P>2. A total of 78 patients with PAD and 241 age- and gender-matched patients without PAD who had chest pain with normal coronary appearance on coronary angiograms underwent intracoronary acetylcholine (ACh) provocation test. Acetylcholine was injected into the left coronary artery in incremental doses of 20, 50 and 100 &mgr;g/min. Significant CAS was defined as a transient > 70% luminal narrowing with concurrent chest pain and/or ST segment changes.</P><P>3. Patients with PAD had a significantly higher incidence of ACh-induced significant CAS than those without PAD (60.3 vs 34.0%, respectively <I>P</I> < 0.001), as well as chest pain and ST segment changes during the ACh provocation test. Patients with PAD were more sensitive to lower doses of ACh and had a higher incidence of multivessel spasm than those without PAD. Multivariable logistic analysis showed that age, current smoking, PAD and myocardial bridge were independent predictors of ACh-induced significant CAS. Moreover, of these factors, PAD was the strongest independent predictor (odds ratio 4.25; confidence interval 1.33–13.54; <I>P</I> = 0.014).</P><P>4. In patients with chest pain, the presence of arterial disease at another site should still push the clinician towards treating the chest pain as angina, even if the coronary anatomy is normal on a coronary angiogram.</P>