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Long-term follow-up of crush versus no crush technique for coronary artery bifurcation lesions

Chinese Medical Journal 2009年第6期122卷 627-631页

作者： gao zhan yang yue-jin xu bo chen ji-lin qiao shu-bin li jian-jun qin xue-wen yao min wu yong-jian yuan jin-qing chen jue liu hai-bo dai jun gao run-lin Department of Cardiology Cardiovascular Institute & Fu Wai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China

Background Lesions at coronary bifurcations always are a big challenge for interventionists even with the advent of drug eluting stents （DES）. Even as more clinical trials are published, operators still can not confirm that one strategy is more efficient than another. Selection of patients and short term follow-up contribute to the difficulty in comparing strategies. Methods From April 2004 to April 2008, 505 consecutive Chinese patients underwent DES implantation for true bifurcation lesions; including 258 using crush strategy （213 male, （56.7＋10.8） years old） and 247 using no crush strategy （206 male, （58.1＋10.1） years old） were analyzed. Results The follow-up period ranged from 237 to 1223 days, average （537＋340） days for the crush group and （538＋351） days for the no crush group. There was no significant difference of major adverse cardiac events （MACE） rate between the two groups （10.1% vs 12.1%; P=-0.481）, nor in cardiac death, nonfatal myocardial infarction （MI） or in the target vessel revascularization （TVR）（0.4% vs 1.6%; P=0.207, 2.7% vs 2.8; P=1.000 and 7.0% vs 7.7%; P=0.865）. The stent thrombosis rate was similar in the two groups （1.6% vs 2.0%; P=0.409）, late and very late stent thrombosis in both groups were very low （0.4% vs 0.4%; P=-1.000）. Seven-month angiographic follow-up showed no significant difference of the restenosis rate between the two groups （11.0% vs 13.5%; P=0.786）. During the follow-up, cardiac death, nonfatal MI, TVR and ST free survival rate showed no significant difference between the two groups. The only variant identified as a predictor of MACE was percutaneous coronary intervention （PCI） in the first two years, which accounted for 47% of patients of all cases in four years. Conclusion Crush technique showed similar long-term clinical effect compared with other two DES techniques for coronary bifurcation lesions, the surgeons＇ skills are very important for reducing clinical events.

关键词： percutaneous coronary intervention drug eluting stent bifurcation

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Is adjunctive balloon postdilatation necessary with drug-eluting stents？ One center experience in Chinese patients

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Chinese Medical Journal 2008年第6期121卷 513-517页

作者： gao zhan yang yue-jin xu bo chen ji-lin qiao shu-bin yao min chen jue wu yong-jian liu hai-bo dai jun yuan jin-qing li jian-jun gao run-lin Department of Cardiology Cardiovascular Institute and FuwalHospital Chinese Academy of Medical Sciences and Peking UnionMedical College Beijing 100037 China

Background With the advent of drug-eluting stents （DES） and much lower rates of target vessel revascularization （TVR）, whether adjunctive balloon postdilatation can further optimize outcome is still unknown. The present study was to compare the outcomes of postdilatation with un-postdilatation following deployment of DES. Methods From April 2004 to September 2006, 6479 consecutive Chinese patients who underwent DES implantation, including 1769 with postdilatation （1454 male, （57.9 ± 10.8） years old） and 4710 without postdilatation （3819 male, （57.9 ± 10.6） years old） were analyzed. Clinical and angiographic follow-up was performed at 7 months. Results Compared with the un-postdilatation group, the postdilatation group had more complex lesions and larger relevant vessel diameter （RVD）. In the postdilatation group, in-stent residual restenosis was significantly improved right after the procedure （（16.80±5.88）% vs （19.60±6.07）%; P=0.000）. There was no statistical difference in the major adverse cardiac events （MACE） rate between the groups （2.9% vs 3.3%; P=0.420）, and there were also no statistical differences in death, acute myocardial infarction （AMI） and target lesion revascularization （TLR） rates in the two groups （0.1% vs 0.4%, P=0.127; 1.7% vs 1.3%, P=0.229; and 1.5% vs 2.0%, P=0.206, respectively）. The in-stent thrombosis rate was almost the same in both groups （0.5% vs 0.5%; P=1.000）. Seven months angiographic follow-up results showed that both in-stent and in-segment restenosis rates were lower in the postdilatation group （8.8% vs 15.6%, P=0.000; and 10.5% vs 17.3%, P=0.000）, and so were instent and in-segment late loss （（0.32±0.12） mm vs （0.49±0.13） mm, P=0.000; and （0.24±0.08） mm vs （0.36±0.09） mm, P=0.001 ）. Conclusion Postdilatation after DES deployment was safe and could reduce the restenosis rate, especially for more complex lesions.

关键词： percutaneous coronary intervention drug-eluting stent postdilatation

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Sirolimus-eluting stents for treatment of drug-eluting versus bare-metal stents restenosis： 42-month clinical outcomes from a Chinese single center

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Chinese Medical Journal 2012年第19期125卷 3398-3403页

作者： YAN Rong-qiang chen ji-lin gao li-jian yang yue-jin li jian-jun qiao shu-bin xu bo yao min qin xue-wen liu hai-bo wu yong-jian yuan jin-qing chen jue YOU Shi-jie dai jun gao run-lin State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Background Restenosis of bare-metal stents （BMS） and drug-eluting stents （DES） has been increasingly treated with sirolimus-eluting stents （SES）, but the long-term outcomes are unknown. Methods In our study, 388 consecutive patients （144 DES restenosis and 244 BMS restenosis） with 400 lesions （147 DES restenosis and 253 BMS restenosis） treated with SES were included. The rates of target lesion revascularization （TLR） and major adverse cardiac events （MACE） at 42 months were analyzed. Results At the mean follow-up of 42 months, the rates of death （3.5% vs. 3.3%, P=1.000） and myocardial infarction （2.8% vs. 1.2%, P=0.431） in the DES group and BMS group were comparable. Compared with the BMS group, ischemia-driven TLR occurred with a higher frequency in the DES group （18.8% vs.10.7%, P=0.024）. This translated into an increased rate of MACE in the DES group （22.2% vs. 14.0%, P=0.034）. Stent thrombosis occurred with a similar frequency in both groups （2.8% vs. 1.6%, P=0.475）. Multivariate analysis showed that DES restenosis （OR=1.907, 95% Cl 1.108-3.285, P=0.020） and smoking （OR=2.069; 95% Cl 1.188-3.605; P=0.010） were independent predictors of MACE.

关键词： restenosis percutaneous coronary intervention drug-eluting stents

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Comparison of drug eluting stents with bare metal stents in daily practice for bifurcation lesions in Chinese patients

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Chinese Medical Journal 2006年第14期119卷 1157-1164页

作者： KANG Sheng yang yue-jin xu bo chen ji-lin qiao shu-bin yao min chen jue wu yong-jian liu hai-bo dai jun yuan jin-qing li jian-jun gao run-lin Department of Cardiology Cardiovascular Institute ＆ Fuwai Hospital Chinese Academy of Medical Sciences ＆ Peking Union Medical College Beijing 100037 China

Background Recently, numerous randomized and controlled trials have demonstrated great advantages of drug eluting stents （DES） with respect to significant reduction of restenosis and recurrence of symptoms and improvement of clinical outcomes after percutaneous coronary intervention （PCI）. little is known about the comparative effects between DES and bare metal stents （BMS） for bifurcation angioplasty in the Chinese population. We compared the inpatient and 7-month follow-up outcomes between DES and BMS for the treatment of bifurcation lesions. Methods From April 2004 to October 2005, 291 Chinese patients [85.9% male, mean age （57.8± 10.4） years] underwent DES （387 lesions） and/or BMS （297 lesions） implantation for bifurcation lesions. Clinical and angiographic follow-up was performed at 7 months. Results Compared with BMS group, patients in DES group had significantly lower rates of restenosis at main branch （9.5% vs 28.7%, P 〈 0.001） or side branch （14.5% vs 37.0%, P 〈 0.001） and major adverse cardiac events （MACE）（14.0% vs 26.3%, P = 0.000）. The occurrence rate of late in-stent thrombosis did not differ between the two groups in both main （0.8% vs 0, P = 0.224） and side branches （1.4% vs 0, P =0.198）. Target lesion revascularization （TLR） was less frequent in DES group for main branch （8.3% vs 21.3%, P 〈 0.001） and for side branch （7.6% vs 23.5%, P 〈 0.001）. Multivariate regression analysis revealed that total stent length （OR = 1.029, P = 0.01）, postprocedural in-stent minimum lumen diameter （OR = 0.476, P = 0.03） and stent type （OR = 3.988, P = 0.0001） were independent predictors of TLR for main branch. Prior history of coronary intervention （OR = 2.424, P =0.041）, angulated lesion （OR = 2.337, P = 0.033）, postdilation （OR = 0.267, P = 0.035） and stent type （DES vs BMS, OR = 5.459, P = 0.000） were independent predictors of TLR for side branch. Conclusion The implantation of DES may be associated with greater reduction of restenosis and TLR than BMS in bi

关键词： percutaneous coronary intervention drug eluting stent bare metal stent bifurcation

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Comparison of immediate and followup results between transradial and transfemoral approach for percutaneous coronary intervention in true bifurcational lesions

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Chinese Medical Journal 2007年第7期120卷 539-544页

作者： yang yue-jin xu bo chen ji-lin KANG Sheng qiao shu-bin qin xue-wen yao min chen jue wu yong-jian liu hai-bo yuan jin-qing YOU Shi-jie li jian-jun dai jun gao run-lin Centre for Coronary Artery Disease Department of Cardiology Cardiovascular Institute and Fuwai Hospital Chinese Academy of Medical Sciences ＆ Peking Union Medical College Beijing 100037 China

Background A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention （PCI） in bifurcations has not been done. This study evaluated feasibility of transradial PCI （TRI） and compared the immediate and followup results with transfemoral PCI （TFI） in bifurcations. Methods One hundred and thirty-four consecutive patients with bifurcations were treated with PCI in our hospital from April 2004 to October 2005. Of these, there were 60 patients （88 lesions） in TRI group and 74 patients （101 lesions） in TFI group. Bifurcations type was classified according to the Institut Cardiovasculaire Paris Sud Classification. Results TRI group had smaller stent diameter （（3.06±0.37） mm vs （3.18±0.35） mm, P=0.023） and postprocedural in-stent minimum lumen diameter （（2.62±0.37） mm vs （2.74±0.41） mm, P=0.029） than TFI, but there were not significant differences in in-stent subacute thrombosis rate （0% vs 1.0%, P=0.349）, target lesion revascularization （TLR）（0% vs 1.0%, P=0.349） following procedure and thrombosis （2.3% vs 1.0%, P=0.482）, in-stent restenosis （12.5% vs 10.9%, P=0.731）, in-segment restenosis （17.0% vs 14.9%, P=0.681）, TLR （10.2% vs 13.9%, P=0.446） and TLR-free cumulative survival rate （89.8% vs 86.1%, P=0.787） at seven months followup. No death was reported in the two groups. Conclusion Transradial intervention is feasible and appears to be as effective and safe as transfemoral PCI in treatment of true bifurcational lesions.

关键词： transradial percutaneous coronary intervention transfemoral percutaneous coronary intervention bifurcational lesions treatment outcome

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Current treatment status in patients with severe aortic valve stenosis and outcome of long term follow-up at advanced age： a Chinese single center study

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Chinese Medical Journal 2011年第18期124卷 2879-2882页

作者： PEI Han-jun wu yong-jian yang yue-jin xu bo chen ji-lin qiao shu-bin li jian-jun qin xue-wen yao min yuan jin-qing chen jue liu hai-bo YOU Shi-jie gao run-lin Department of Cardiology Cardiovascular Institute and Fu WaiHospital Chinese Academy of Medical Sciences and Peking UnionMedical College Beijing 100037 China

Background Surgical aortic valve replacement is the standard treatment for patients with severe aortic stenosis, but some registries have indicated that 30% to 60% of these patients are not treated surgically, usually due to advanced age and/or comorbidities. This single center study in China investigated the current treatment status in the patients with severe aortic stenosis and evaluated the long term clinical outcome in advanced age patients whether or not undergoing aortic valve replacement. Methods Clinical data of 867 consecutive patients with severe aortic stenosis between January 2000 and December 2006 were retrospectively analyzed. The patients 〉65 years old were followed up by telephone or information from medical records. The primary end-point was all-cause mortality. Results The patients＇ average age was （52±19） years （range, 1-91 years）, and 34% were women. The percentages of the patients aged 〈15 years, between 15 and 34 years, between 35 and 54 years, between 55 and 64 years, between 65 and 74 years, and 〉75 years who underwent surgical aortic valve replacement were 82.3%, 87.2%, 88.8%, 78.2%, 65.3% and 22.2% respectively. In the patients （n=256）〉65 years old, 43.4% had New York Heart Association class III and IV symptoms, 39.1% had hypertension, 33.2% had coronary heart disease, and 3.1% had stroke. In the patients not undergoing aortic valve replacement, 1.6% had renal insufficiency, 4.7% had chronic obstructive pulmonary disease, 2.0% had critical hematopathy, and 0.4% had mammary cancer. A total of 186 （72.7%） patients finished the follow-up, and the average duration of the follow-up was （60±2.6） months. In the patients between 65 and 74 years old, the total deaths and cardiac deaths in the patients undergoing aortic valve replacement decreased significantly compared with those with conservative treatment （10.3% vs. 53.7%, P 〈0.001 and 6.3% vs. 50.7%, P〈0.001）. Similarly, in the patients ≥75 years old, there was a significant difference between

关键词： aortic stenosis aortic valve replacement advanced age comorbidity

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A single center investigation of bare-metal or drug-eluting stent restenosis from 1633 consecutive Chinese Han ethnic patients

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Chinese Medical Journal 2006年第7期119卷 533-538页

作者： xu bo li jian-jun yang yue-jin MA Wei-hua chen ji-lin qiao shu-bin qin xue-wen yao min liu hai-bo wu yong-jian yuan jin-qing chen jue YOU Shi-jie dai jun XIA Ran gao run-lin Department of Cardiology Fuwai Hospital Chinese Academy ofMedical Sciences Peking Union Medical College Beijing 100037China

Background Stents are widely used in China but the clinical impression is somehow that restenosis is less common because of the lower prevalence of coronary artery disease （CAD） and associated risk factors in Chinese populations. However, no large-sample published studies are available on angiographic stent restenosis including those of bare-metal stent （BMS） or drug-eluting stent （DES） in Chinese Han ethnic population. Mothods A total of 1633 consecutive patients with CAD who had undergone coronary stenting, quantitative coronary angiography （QCA） were retrospectively studied. At the time of stent implantation and at 7 months post-stenting 675 patients had a follow-up angiography. Statistical analysis was made with the chi-square test for categorical variables, unpaired t test for continuous variables, univariate or multivariate regression for baseline and angiographic characteristics and the Kaplan-Meier method for rate of target lesion revascularization （TLR）. Results Stent restenosis was defined as ≥50% diameter stenosis in the dilated segment. A total of 675 patients with 1074 lesions were subjected to angiographic follow-up for 7 months on average, Of these lesions, 448 were implanted with BMS whereas 626 lesions with DES. At 7 months, bare-metal in-stent restenosis occured in 148 lesions （33.0%）, and bare metal in-segment restenosis in 155 lesions （34.6%） in contrast to drug-eluting in-stent restenosis in 48 lesions （7.7%） and drug-eluting in-segment restenosis in 73 lesions （11.7%）（P〈0.001 compared with BMS respectively）. Late loss in both in-stent and in segment was higher in BMS than in DES groups [（1.00±0.69） vs （0.28±0.52）; （0.78±0.71） vs （0.21±0.52）, P〈0.001 respectively]. Angulated lesion, lesion length, pre-procedural minimal luminal diameter （MLD）, and BMS were independent predictors for TLR, （P〈0.01 respectively）, whereas current smoker, ostial lesion, and stent overlapping, post-procedure in-stent MLD, lesion length, and stent types were indep

关键词： stent coronary artery disease angiography restenosis

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Two-year clinical outcome after successful implantation of drug-eluting and bare metal stents in diabetic patients： results from a real-world single center registry

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Chinese Medical Journal 2009年第6期122卷 612-616页

作者： DOU Ke-fei xu bo yang yue-jin chen ji-lin qiao shu-bin li jian-jun qin xue-wen liu hai-bo wu yong-jian chen jue yao min YOU Shi-jie yuan jin-qing dai jun gao run-lin Department of Cardiology Cardiovascular Institute and Fu Wai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China

Background Drug-eluting stents （DES） have revolutionized the field of interventional cardiology by dramatically improving clinical and angiographic outcomes. Patients with diabetes mellitus （DM） are associated with an increased risk of adverse clinical outcomes after a percutaneous coronary intervention （PCI）. Available information on the efficacy and safety of DES and bare metal stent （BMS） in diabetic patients remains scarce. Methods From April 2004 to October 2006, 1565 patients with diabetes, who successfully underwent elective stenting at Fu Wai Hospital in Beijing, China, were enrolled in this study. All enrolled patients were assigned to a drug eluting stent group and a bare metal stent group. We obtained follow-up data： death, myocardial infarction （MI）, thrombus, target lesion revascularization （TLR）, and target vessel revascularization （TVR） at 30 days and 12 and 24 months, as defined by the Academic Research Consortium （ARC）. We calculated and compared all the unadjusted cumulative frequencies of the various adverse events in the two groups. Cox＇s proportional-hazards models adjusted with the propensity score were used to assess the relative risks of all the outcome measures at 24 months. Results At 24 months, all ARC defined stent thrombosis in the two groups were similar; at 30 days, a more definite thrombosis was found in the BES group （0.08% vs 0.81%, P=0.016）. Patients treated with DES showed a significant lower risk of TLR （3.88% vs 10.89%; hazard ratio （HR） 0.159 （95% CI： 0.151-0.444）, P 〈0.001）, TVR （5.48%vs 11.69%; HR 0.383 （95% CI： 0.232-0.633）, P 〈0.001）, and any revascularization （12.47% vs 18.55%; HR 0.555 （95% CI： 0.370-0.831）, P=0.0004） at 24 months. No significant difference was apparent in terms of all-cause mortality, MI, and all-cause mortality/MI. Conclusions In contemporary society＇s large, diabetic population, the use of DES is associated with long-term significant reductions in the risks of TLR, TVR, and any revascularization.

关键词： clinical outcome diabetes drug-eluting stent bare metal stent

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Long-term clinical outcomes after bioabsorbable polymer- and durable polymer-based sirolimus-eluting stents implantation： two-year follow-up results from a large single-center database

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Chinese Medical Journal 2009年第6期122卷 681-686页

作者： liu hai-bo xu bo yang yue-jin WANG yang qin xue-wen yao min wu yong-jian yuan jin-qing chen jue YOU Shi-jie dai jun MA Wei-hua li jian-jun qiao shu-bin chen ji-lin li Wei gao run-lin Department of Cardiology Fu Wai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China

Background Several clinical trials have shown that sirolimus-eluting stents significantly reduce the risk of restenosis after percutaneous coronary intervention （PCI）. The FIREBIRD stent （coated with durable polymer） and the EXCEL stent （coated with bioabsorbable polymer） are two different types of sirolimus-eluting stents made in China; both have been approved for clinical use in China by the State Food and Drug Administration. The mid-term （6-month） angiographic and clinical results of both stents have been confirmed exciting perspective outcomes. However, it is unclear whether there are differences in the long-term safety and efficacy between the two types of stents in daily practice.Methods All consecutive patients undergoing elective PCI with EXCEL or FIREBIRD stents between june 1,2006 and December 31, 2006 at Fu Wai Hospital in Beijing were included. Patients were classified from the index admission according to stent types （EXCEL or FIREBIRD） used. Clinical and procedural risk factors were collected prospectively. With propensity score matching without replacement, the frequency of major adverse cardiac events （MACE, a composite of death, myocardial infarction or target vessel revascularization） and stent thrombosis during a 2-year follow-up period were compared between the two groups.Results A total of 474 patients were treated with EXCEL, and 640 were treated with FIREBIRD. Three hundred and ninety-seven EXCEL patients were matched to 397 FIREBIRD patients, 2-year risk-adjusted MACE rates were 6.1% in EXCEL group and 7.6% in FIREBIRD group （HR 0.84, 95%CI0.50-1.43）, whereas the respective rates for mortality, myocardial infarction and target-vessel revascularization were 2.3% vs 2.8% （HR 0.74, 95%CI0.30-0.85）, 1.8% vs 1.3% （HR 1.41,95%CI 0.45-4.43） and 2.5% vs 4.0% （HR 0.62, 95%CI0.28-0.37）, respectively. Cumulative incidence of stent thrombosis at 2 years was 1.8% in the EXCEL group vs 1.3% in the FIREBIRD group （P=0.5610）, whereas the rate of very la

关键词： percutaneous coronary intervention drug-eluting stent bioabsorbable polymer long-term comparative study

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Incidence of thrombosis after implantation of drug-eluting stents in patients with coronary artery disease

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Chinese Medical Journal 2008年第21期121卷 2144-2147页

作者： chen ji-lin yang yue-jin gao li-jian HUANG jing-han qin xue-wen qiao shu-bin xu bo yao min liu hai-bo wu yong-jian yuan jin-qing chen jue YOU Shi-jie dai jun li jian-jun gao run-lin Department of Cardiology Cardiovascular Institute & Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background Randomized clinical trials have demonstrated equivalent safety to bare-metal stents after drug-eluting stents （DES） implantation. However, the DES thrombosis in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. This study sought to assess the incidence of DES thrombosis after implantation of DES in patients with real world coronary artery disease （CAD） in China. Methods From December 2001 to April 2007, 8190 consecutive patients received the treatment with DES, 5412 patients completed one year follow-up： 2210 with sirolimus-eluting stent Cypher, 1238 with paclitaxel-eluting stent Taxus and 1964 with Chinese sirolimus-eluting stent Firebird, After two years of follow-up, there were 2176 patients （1245 Cypher, 558 Taxus and 373 Firebird）. All patients were treated with aspirin and clopidogrel over at least 9 months. Results Among 8190 patients, 17 patients had acute stent thrombosis （0.24%）： 7 in the Cypher group, 4 Taxus and 6 Firebird; 23 patients had subacute stent thrombosis： 8 Cypher, 6 Taxus and 9 Firebird. The incidence of acute and subacute thrombosis was 0.49%： 0.50% Cypher, 0.63% Taxus and 0.41% Firebird. The incidence of late thrombosis at one year followup was 0.63%： 0.63% Cypher, 0.88% Taxus and 0.46% Firebird; at two year follow-up the incidence was 0.74%： 0.72% Cypher, 0.90% Taxus and 0.54% Firebird. There was no significant difference among three groups at 1 year and 2 years follow-up. Conclusion The first generation DES in the treatment of complex lesions are safe and effective if patients are aggressively treated with dual antiplatelet agents.

关键词： drug-eluting stents coronary disease thrombosis safety

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