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percutaneous coronary intervention for chronic total occlusion in 1263 patients:a single-center report

Chinese Medical Journal 2006年第14期119卷 1165-1170页

作者： HAN Ya-ling WANG Shou-li JING Quan-min LI Yi ZHANG Jian MA Ying-yan LUAN Bo Department of Cardiology Shenyang General Hospital of PLA Shenyang 110016 China

Background coronary chronic total occlusion （CTO） remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI） for CTO. Methods Clinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed. Results There were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8 % （1147/1263） and 88.9 % （1445/1625）, respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals ≥15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions （P〈 0.05）. Procedural failure occurred in 116 patients, caused by impossibility of guide-wire （81.0%） or balloon （19.0%） to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary ftstula during in-hospital period. The overall in-hospital MACE rate was 0.6% （8/1263）. Drug-eluting stents were used in 198 patients without in-hospital MACE. Conclusions In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with

关键词： coronary heart disease chronic total occlusion angioplasty, transluminal percutaneous coronary

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Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

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World Journal of Cardiology 2015年第10期7卷 594-602页

作者： Ariel Beresniak Thibaut Caruba Brigitte Sabatier Yves Juillière Olivier Dubourg Nicolas Danchin Data Mining International Research and Development Paris-Descartes University Department of Pharmacy Hopital Européen Georges Pompidou Department of Cardiology Institut Lorrain du Coeur et des Vaisseaux Department of Cardiology Hopital Ambroise Paré UFR des Sciences de la Santé Simone Veil Université Versailles Saint Quentin en Yvelines Division of coronary Artery Disease and Intensive Cardiac Care Hopital Européen Georges Pompidou

The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents(DES) vs bare metal stent(BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years(60% of success) when compared to BMS(58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs(P coronary artery disease and long-term evidence become available.

关键词： Cost-effectiveness percutaneous coronary coronary artery disease Drug eluting stent

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Midterm outcomes of prospective,randomized,single-center study of the Janus tacrolimus-eluting stent for treatment of native coronary artery lesions

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Chinese Medical Journal 2007年第7期120卷 552-556页

作者： HAN Ya-ling WANG Shou-li JING Quan-min YU Hai-bo WANG Bin MA Ying-yan LUAN Bo WANG Geng Department of Cardiology Shenyang General Hospital of PLA Shenyang 110016 China

Background Long-term efficacy and safety of tacrolimus-eluting stent （Janus） for treatment of coronary artery disease in percutaneous coronary interventions （PCI）＂real wodd＂ is uncertain. The aim of this study was to evaluate the efficacy and safety of Janus stent for treating coronary heart disease in PCI daily practice, the safety of 4-month clopidogrel therapy after Janus stent implantation and the feasibility for treating patients with acute myocardial infarction （AMI） for first time. Methods From February 20, 2006 to August 26, 2006, a total of 200 patients were enrolled and randomly assigned to receive either Janus stent （n=100） or bare metal stent （Tecnic Carbostent, n=100）. All patients were administered with clopidogrel for 4 months and aspirin for life long after stenting. Results Baseline clinical and angiographic characteristics were comparable between the two groups. AMI was present in 37% of patients with Janus and 36% with Tecnic Carbostent. At an average of 246-day follow-up, major adverse cardiac events （MACE） was 6% with the Janus stent and 15% with the Tecnic Carbostent （P=0.038）. Primary events included 1 cardiac death, 1 myocardial infarction （MI） due to subacute stent thrombosis and 13 target lesion revasculadzations （TLR） due to restenosis in patients with Tecnic Carbostent and 6 TLR due to restenosis in patients with Janus stent. Although all patients had discontinued clopidogrel for an average of 126 days, there was no additional thrombotic event in the two groups. Conclusions Janus stent is efficient in reducing MACE compared with Tecnic Carbostent at an average of 8-month follow-up. Discontinuation of clopidogrel at 4 months after PCI is safe for patients with Janus stent, including AMI patients Long-term efficacy of Janus stent in reducing restenosis requires further study.

关键词： drug-eluting stent acute myocardial infarction angioplasty, transluminal percutaneous coronary

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