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Comparison of percutaneous interventions for unstable angina pectoris in patients with and without previous coronary artery bypass grafting

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第9期86卷 931-937页

作者： Mathew, V Berger, PB Lennon, RJ Gersh, BJ Holmes, DR Mayo Clin & Mayo Fdn Rochester MN 55905 USA

An increasing number of patients who have undergone previous coronary artery bypass grafting (CABG) are referred for percutaneous coronary revascularization. We identified patients who underwent percutaneous intervention for unstable angina from 1990 to 1998 at our institution and assigned them into 2 groups based on whether or not they had undergone previous CABG. There were 1,431 patients with and 4,629 patients without previous CABG. Previous CABG patients were older, had more atherosclerotic risk factors, more heart failure, lower ejection fraction, more multivessel disease, more multilesion treatment, more complex lesions, and less complete revascularization. Adjusting for baseline differences, previous CABG was associated with worse long-term mortality (RR 1.47, 95% confidence intervals [CI] 1.22 to 1.77, p <0.001) and death, myocardial infarction, and/or revascularization (RR 1.16, 95% CI 1.04 to 1.30, p = 0.01);treatment of native lesions in patients with previous CABG versus treatment of vein graft lesions was associated with a reduction in this composite end point (RR 0.75, 95% CI 0.65 to 0.87, p <0.001). Post-CABG patients treated between 1995 and 1998 had lower long-term mortality (RR 0.76, 95% CI 0.59 to 0.99, p = 0.04) and death, myocardial infarction, and/or revascularization (RR 0.76, 95% CI 0.66 to 0.88, p <0.001) compared with those treated between 1990 and 1994. Thus, in patients with unstable angina referred for percutaneous revascularization, previous CABG is associated with reduced event-free survival, although the outcome of post-CABG patients treated from 1995 to 1998 is superior to that observed in patients treated from 1990 to 1994. In patients who underwent previous CABG, treatment of native lesions affords better long-term outcome than vein graft intervention. (C)2000 by Excerpta Medico, Inc.

关键词：方差分析心绞痛不稳定型/死亡率心绞痛不稳定型/外科学血管成形术经腔经皮冠状动脉/方法血管成形术经腔经皮冠状动脉/死亡率卡方分布冠状动脉分流术/方法随访研究移植物闭塞血管/病因学移植物闭塞血管/放射摄影术移植物闭塞血管/治疗比值比概率前瞻性研究登记存活率治疗结果女(雌)性人类男(雄)性中年人

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HOCKEY STICK GUIDING CATHETER

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1992年第4期5卷 331-336页

作者： MEHTA, S MARGOLIS, JR Miami Heart Institute Miami Beach Florida.

Guiding catheter strategies form an important component of successful PTCA. Selection of appropriate guiding catheters is essential for providing adequate back-up support and visualization. Hockey stick guiding cathet... 详细信息

关键词：血管成形术经腔经皮冠状动脉/仪器和设备血管成形术经腔经皮冠状动脉/方法冠状血管造影术设备设计人类

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Six-month angiographic follow-up after intravascular ultrasound-guided stenting of infarct-related artery: Comparison non-infarct-related artery

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AMERICAN HEART JOURNAL 2001年第5期141卷 832-836页

作者： Hong, MK Park, SW Lee, CW Rhee, KS Song, JM Kang, DH Song, JK Kim, JJ Park, SJ Univ Ulsan Asan Med Ctr Cardiac Ctr Coll MedDept Internal Med Seoul 138736 South Korea

Background Compared with balloon angioplasty, stenting has been established as an effective treatment modality to reduce restenosis in patients with acute myocardial infarction. However, the immediate results that predict favorable long-term outcomes in the acute infarct stenting are unknown. Therefore, we evaluated long-term outcomes of stenting for infarct-related artery (IRA) lesions by using intravascular ultrasound (IVUS) compared with that of stenting for non-IRA lesions. Methods IVUS-guided coronary stenting was successfully performed in 510 native coronary lesions (105 IRA vs 405 non-IRA). A 6-month follow-up angiogram was performed in 419 (82.2%) lesions: 87 (82.9%) IRA lesions and 332 (82.0%) non-IRA lesions. Coronary stenting on the IRA lesions was successfully performed within 7 to 10 days after onset of infarction in 42 patients and within 12 hours in 45 patients. Results were evaluated by clinical, angiographic, and IVUS methods. Results There were no significant differences in clinical and angiographic variables between the two groups. IVUS variables including reference vessel area and minimal stent area were also similar between the two groups, There was no significant difference in angiographic restenosis rate between the two groups in cases of minimal stent area greater than or equal to7 mm(2): 12.8% (6 of 47) in IRA versus 19.1% (33 of 173) in non-IRA lesions (P = .315). However, the angiographic restenosis rate in cases of minimal stent area <7 mm(2) was 50% (20 of 40) in IRA lesions versus 31.5% (50 of 159) in non-IRA lesions (P = .028). Conclusions Angiographic restenosis is significantly higher in stenting for IRA lesions compared with that for non-IRA lesions in cases of minimal stent area <7 mm(2).

关键词：血管成形术经腔经皮冠状动脉/仪器和设备血管成形术经腔经皮冠状动脉/方法置信区间冠状血管造影术冠状血管/超声检查随访研究心肌梗死/放射摄影术心肌梗死/治疗心肌梗死/超声检查预后复发支架时间因素超声检查介入性女(雌)性人类男(雄)性中年人

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Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease:: Two-year follow-up of a new hybrid procedure compared with "on-pump" double bypass grafting

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AMERICAN HEART JOURNAL 2001年第4期142卷 563-570页

作者： de Cannière, D Jansens, JL Goldschmidt-Clermont, P Barvais, L Decroly, P Stoupel, E Erasme Univ Hosp Dept Cardiac Surg B-1070 Brussels Belgium Erasme Univ Hosp Dept Anesthesiol B-1070 Brussels Belgium Erasme Univ Hosp Dept Invas Cardiol B-1070 Brussels Belgium Duke Univ Hosp Div Cardiol Durham NC USA

Objective Percutaneous transluminal coronary angioplasty (PTCA) or surgery can be chosen as first-line therapies in multiple-vessel coronary disease. A mammary-to-left anterior descending (LAD) graft is the most important statistical determinant of a favorable outcome after coronary artery bypass grafting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CABG in terms of patency rates. Our purpose was to compare a combination of minimally invasive direct coronary artery bypass (MIDCAB) and PTCA with double CABG as a treatment for double-vessel coronary artery disease involving the proximal LAD. Methods Two matched groups of 20 patients with double-vessel coronary disease undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, complications, hospital costs, quality of life, and 2-year follow-up of ischemia are reported. Results All bypasses were patent at early control. Three adverse events were noted in group 1 and 17 in group 2. The hybrid-procedure group exhibited a shorter intensive care unit stay, fewer blood products transfused, less pain, better early quality of life, faster return to work, and similar cost. Three patients required a second PTCA in group 1, one of which For restenosis. At 2 years all the patients are asymptomatic with no residual ischemia. Conclusions We conclude from this pilot study that the hybrid procedure is feasible and appears to be a safe therapy for double-vessel coronary artery disease and that it appears to generate less perioperative morbidity than classic double CABG does. Therefore we believe that there is room to undertake prospective randomized studies on a larger-scale basis.

关键词：血管成形术经腔经皮冠状动脉/方法心肺转流术综合疗法冠状血管造影术/统计学和数值数据冠状动脉分流术/方法冠心病/诊断冠心病/外科学冠心病/治疗随访研究移植物闭塞血管/诊断移植物闭塞血管/流行病学健康状况胸廓内动脉-冠状动脉吻合术/方法疼痛测定试点项目生活质量问卷调查治疗结果老年人女(雌)性人类男(雄)性中年人

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A1166C polymorphism of the angiotensin II type 1 receptor gene and risk of adverse events after coronary catheter interventions

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AMERICAN HEART JOURNAL 2000年第1期140卷 170-175页

作者： Stangl, K Cascorbi, I Stangl, V Laule, M Mrozikiewicz, PM Schwarz, M Felix, SB Theres, H Baumann, G Roots, I Humboldt Univ Univ Klin Charite Med Klin & Poliklin Schwerpunkt Kardiol Angiol & Pneumol D-10117 Berlin Germany Humboldt Univ Univ Klin Charite Inst Klin Pharmakol D-10117 Berlin Germany

Background Contradictory reports exist concerning the role of the angiotensin II type 1 receptor A1166C polymorphism as a coronary risk factor. Moreover, it is unknown whether the A1166C polymorphism is associated with thrombotic complications after coronary catheter interventions. Methods We investigated the role of the A1166C polymorphism as a risk factor in 1000 patients with coronary artery disease (CAD) and in 1000 age- and sex-matched controls. A total of 649 patients receiving interventions (270 coronary angioplasty, 102 atherectomy, and 277 stenting) were investigated for a 30-day composite end point including target vessel revascularization, myocardial infarction, or death. Results The composite end point was reached by 42 patients (6.5%) without evidence that the C allele was associated with excess procedural risk (odds ratio 0.93;95% confidence interval 0.79-1.75;P = .82). Further analyses by device failed to show linkage with adverse events complicating coronary angioplasty, atherectomy, and stenting. Moreover, in the entire CAD group (n = 1000), the polymorphism even showed a trend to underrepresentation (odds ratio 0.83;95% confidence interval 0.69-1.004 P = .054). Conclusions These results indicate that the A1166C polymorphism neither represents a risk Factor for adverse events complicating coronary interventions nor seems to have significant impact on further long-term processes such as development and severity of CAD.

关键词：血管成形术经腔经皮冠状动脉/方法病例对照研究置信区间冠心病/诊断冠心病/遗传学冠心病/治疗冠状动脉血栓形成/流行病学冠状动脉血栓形成/病因学冠状动脉血栓形成/遗传学冠状动脉血栓形成/治疗发病率比值比多态现象遗传概率预后受体血管紧张素 1型受体血管紧张素 2型受体血管紧张素/遗传学参考值危险因素老年人女(雌)性人类男(雄)性中年人

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Does ticlopidine reduce reocclusion and other adverse events after successful balloon angioplasty of occluded coronary arteries? Results from the Total Occlusion Study of Canada (TOSCA)

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AMERICAN HEART JOURNAL 2001年第5期142卷 776-781页

作者： Berger, PB Dzavik, V Penn, IM Catellier, D Buller, CE Mayo Clin & Mayo Fdn Div Cardiovasc Dis Rochester MN 55905 USA Univ Hlth Network Dept Cardiol Toronto ON Canada Vancouver Gen Hosp Vancouver BC Canada Univ N Carolina Dept Biostat Collaborat Studies Coordinating Ctr Chapel Hill NC USA

Objectives Ticlopidine reduces stent thrombosis and other adverse events among patients receiving coronary stents. Whether ticlopidine is beneficial after balloon angioplasty is unknown. Our purpose was to compare the clinical outcome of patients undergoing balloon angioplasty treated with both aspirin and ticlopidine versus aspirin alone. Methods and Results We performed a databank analysis of the Total Occlusion Study of Canada (TOSCA), a randomized trial with angiographic follow-up comparing the frequency of reocclusion after angioplasty of a subtotal or total coronary occlusion in patients receiving greater than or equal to1 heparin-coated Palmaz-Schatz stent versus balloon angioplasty alone. In TOSCA, 102 patients undergoing balloon angioplasty were treated with both aspirin and ticlopidine (generally for 15-30 days) and 94 were treated with aspirin alone, by physician preference. After 6 months, failure to sustain potency (less than Thrombolysis in Myocardial Infarction [TIMI] grade 3 flow on follow-up angiography) occurred in 23% of patients on ticlopidine and aspirin versus 16% of patients on aspirin alone (P = .21);the frequency of target vessel revascularization was also similar in the 2 groups (32% vs 25%, P = .27). Myocardial infarction was infrequent in both groups (2.0% vs 1.1%, respectively, P not significant). Patients treated with aspirin and ticlopidine had more adverse angiographic and procedural characteristics, including longer lesions and treatment lengths. Multivariate analysis to adjust for these and other differences failed to reveal a benefit of ticlopidine in maintaining potency and reducing adverse clinical events. Conclusions After balloon angioplasty of a subtotal or total coronary occlusion, no reduction in adverse events was observed among patients in, whom ticlopidine was added to aspirin, even after adjustment for clinical and lesion characteristics.

关键词：血管成形术经腔经皮冠状动脉/方法阿司匹林/治疗应用冠心病/治疗冠状动脉再狭窄/预防和控制药物疗法联合噻氯匹定/治疗应用治疗结果人类

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Intracoronary serotonin release after high-pressure coronary stenting

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第11期84卷 1317-1322页

作者： Leosco, D Fineschi, M Pierli, C Fiaschi, A Ferrara, N Bianco, S Longobardi, G Pisani, E Bravi, A Rengo, F Univ Naples Federico II Cattedra Geriatr Fac Med Ist Med Interna Cardiol & Chirurg Cardiovasc I-80131 Naples Italy Emodinamica Policl Scotte Malattie Cardiovasc UO 2 Siena Italy Univ Siena Ist Farmacol I-53100 Siena Italy Fdn Salvatore Maugeri Terme Italy

It is known that platelet-derived serotonin at the site of coronary angioplasty induces an increase in coronary tone and plays a role in vasoconstriction after balloon angioplasty. The goal of the present investigation was to compare local release of serotonin with changes in coronary tone after coronary stenting and coronary angioplasty. Twenty patients with significant stenosis (greater than or equal to 50% diameter narrowing) of the left anterior descending coronary artery were referred to traditional coronary angioplasty (10 patients;group 1) or high-pressure coronary stenting (10 patients;group 2). An additional 16 patients with similar angiographic characteristics were referred to the coronary angioplasty group (8 patients;group la) or stenting group (8 patients;group 2a) after pretreatment with ketanserin. Serotonin plasma levels in coronary sinus and coronary cross-sectional area distal to the site of dilatation were measured before and after both revascularization procedures. In groups 1 and la, plasma serotonin levels in coronary sinus increased from basal values of 3.2 +/- 0.8 and 3.2 +/- 0.5 ng/ml to 29.5 +/- 13 and 25.6 +/- 9 ng/ml after ballooning (p <0.001 vs baseline). In groups 2 and 2a, plasma serotonin levels in coronary sinus increased from basal values of 3.5 +/- 0.3 and 3.5 +/- 0.7 ng/ml to 114.6 +/- 34 and 113 +/- 29 ng/ml after scenting (p <0.001 vs baseline and vs postangioplasty values in groups 1 and 1a). Coronary cross-sectional area distal to the site of dilatation significantly decreased after angioplasty in group 1 (from 4.33 +/- 0.4 to 3.32 +/- 0.3 mm(2) p <0.001), and after stenting in group 2 (from 4.27 +/- 1.3 to 2.86 +/- 0.2 mm(2);p <0.001 vs baseline, and p <0.02 vs values after coronary angioplasty in group 1). Pretreatment with ketanserin significantly reduced distal coronary vasoconstriction after angioplasty and stenting. It is concluded that the higher local serotonin release after coronary stenting may explain the more mark

关键词：血管成形术经腔经皮冠状动脉/方法生物学标记/血液血压冠状血管造影术冠心病/血液冠心病/病理生理学冠心病/放射摄影术冠心病/治疗冠状血管/病理生理学手术后期间压力预后放射免疫测定血清素/血液支架血管收缩女(雌)性人类男(雄)性中年人

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Economic assessment of rheolytic thrombectomy versus intracoronary urokinase for treatment of extensive intracoronary thrombus: Results from a randomized clinical trial

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AMERICAN HEART JOURNAL 2001年第4期142卷 648-656页

作者： Cohen, DJ Ramee, S Baim, DS Sharma, S Carrozza, JP Cosgrove, R Jones, N Berezin, RH Cutlip, DE Ho, KKL Kuntz, RE Beth Israel Deaconess Med Ctr Div Cardiovasc Boston MA 02215 USA Harvard Clin Res Inst Boston MA 02115 USA Harvard Univ Sch Med Boston MA USA Harvard Univ Sch Publ Hlth Dept Hlth Policy & Management Boston MA 02115 USA Oschner Clin New Orleans LA USA Mt Sinai Hosp Div Cardiol New York NY 10029 USA

Background Despite advances in mechanical and pharmacologic therapy, thrombus-containing lesions are at high risk for adverse events and remain a challenging subset for percutaneous coronary revascularization. Recently, rheolytic thrombectomy with the AngioJet device has been shown to safely remove intracoronary thrombus, but the overall cost-effectiveness of this technique is unknown. Methods We determined in-hospital and 1-year follow-up costs for 349 patients with overt intracoronary thrombus who were randomly assigned to treatment with intracoronary urokinase (6- to 30-hour infusion followed by definitive revascularization;n = 169) or immediate thrombectomy with the AngioJet device (n = 180) as part of the Vein Graft AngioJet Study (VeGAS) 2 trial. Catheterization laboratory costs were based on measured resource utilization and 1998 unit costs, whereas all other costs were estimated from hospital charges and cost center-specific cost-to-charge ratios. Results Compared with urokinase, rheolytic thrombectomy reduced the incidence of periprocedural myocardial infarction (12.8% vs 30.3%, P < .001) and major hemorrhagic complications (2.8% vs 11.2%, P < .001) and shortened length of stay by nearly 1 day (4.2 vs 4.9 days;P = .02). As a result, AngioJet treatment reduced procedural costs, hospital room/nursing costs, and ancillary costs with resulting hospital cost savings of approximately $3500 per patient during the initial hospitalization ($15,311 vs $18,841, P < .001). These cost savings were maintained at 1 year of follow-up ($24,389 vs $29,109, P < .001). Conclusions Compared with standard treatment with intracoronary urokinase, rheolytic thrombectomy both improves clinical outcomes and reduces overall medical care costs for patients with extensive intracoronary thrombus.

关键词：血管成形术经腔经皮冠状动脉/经济学血管成形术经腔经皮冠状动脉/方法冠状动脉血栓形成/药物疗法冠状动脉血栓形成/经济学冠状动脉血栓形成/外科学纤维蛋白溶解药/投药和剂量纤维蛋白溶解药/经济学纤维蛋白溶解药/治疗应用卫生保健费用血液流变学输注动脉内血栓切除术/经济学血栓切除术/仪器和设备血栓切除术/方法治疗结果人类

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Preconditioning during percutaneous transluminal coronary angioplasty by endogenous and exogenous adenosine

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AMERICAN HEART JOURNAL 2000年第5期140卷 813-820页

作者： Heidland, UE Heintzen, MP Schwartzkopff, B Strauer, BE Univ Dusseldorf Dept Cardiol Pneumol & Angiol Sch Internal Med D-40225 Dusseldorf Germany

Background The purpose of this study was to assess whether pharmacologic preconditioning by exogenous or endogenous adenosine prevents the deterioration of hemodynamic function and left ventricular performance during percutaneous transluminal coronary angioplasty (PTCA). Ischemic preconditioning renders the heart more resistant to subsequent ischemia. Adenosine plays a key role in its pathogenesis. Coronary angioplasty is a suitable model for the induction of myocardial ischemia. Methods and Results We investigated 30 patients receiving PTCA of the left anterior descending coronary. Patients were randomly allocated to either dipyridamole, leading to the liberation of endogenous adenosine (0.5 mg/kg body weight, intracoronary), exogenous adenosine (20 mg intracoronary), or an equal amount of saline. Chest pain, tolerated inflation time, and ST-segment shift were registered. Left ventricular hemodynamics, isovolumetric phase indexes, indexes of volume, election fraction, and indexes of diastolic dysfunction were analyzed. Patients receiving endogenous or exogenous adenosine tolerated longer balloon inflation times (dipyridamole, 208 +/- 23 seconds;adenosine, 188 +/- 41 seconds;control, 153 +/- 36 seconds;P < .05). Deterioration of left ventricular ejection fraction was less severe after adenosine (72% +/- 5% before PTCA vs 64% +/- 6% during angioplasty;P = .11) and could be prevented by intracoronary dipyridamole (69% +/- 12% before PTCA vs 68% +/- 11% after PTCA;P < .01) compared with the control group (71% +/- 7% before PTCA vs 60% +/- 7% during angioplasty). Conclusions Intracoronary application of exogenous adenosine and liberation of endogenous adenosine increase the tolerance to ischemia and prevent deterioration of left ventricular function during ischemia. These findings can be attributed to ischemic preconditioning. However, endogenous adenosine exceeds the protective effects of exogenous adenosine.

关键词：腺苷/投药和剂量腺苷/代谢血管成形术经腔经皮冠状动脉/方法混杂因素(流行病学) 冠状血管造影术双嘧达莫/治疗应用缺血预处理心肌/方法心肌收缩/药物作用血小板聚集抑制剂/治疗应用每搏输出量/药物作用时间因素治疗结果血管舒张药/投药和剂量心室功能障碍左/代谢心室功能障碍左/病理学心室功能左/药物作用老年人女(雌)性人类男(雄)性中年人

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Comparison of rotational atherectomy with conventional balloon angioplasty in the prevention of restenosis of small coronary arteries: Results of the Dilatation vs Ablation Revascularization Trial Targeting Restenosis (DART)

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AMERICAN HEART JOURNAL 2003年第5期145卷 847-854页

作者： Mauri, L Reisman, M Buchbinder, M Popma, JJ Sharma, SK Cutlip, DE Ho, KKL Prpic, R Zimetbaum, PJ Kuntz, RE Brigham & Womens Hosp Div Clin Biometr Boston MA 02115 USA Brigham & Womens Hosp Div Cardiovasc Med Boston MA 02115 USA Harvard Univ Sch Med Boston MA USA Swedish Med Ctr Seattle WA USA Mt Sinai Hosp New York NY 10029 USA Scripps Mem Hosp La Jolla CA USA Harvard Univ Clin Res Inst Boston MA 02115 USA Beth Israel Deaconess Med Ctr Div Cardiovasc Med Boston MA 02215 USA

Background The optimum treatment of obstructive coronary disease in small (2 times normal with an elevated creatine kinase-myocardial band isoenzyme level) occurred in 2.2% and 1.4% of the patients in the rotational a... 详细信息

Background The optimum treatment of obstructive coronary disease in small (<3.0 mm diameter) arteries remains unknown. Rotational atherectomy is an approved treatment that might reduce the vascular injury during percutaneous coronary intervention compared with angioplasty. We report on a multicenter, randomized, blinded end point trial comparing rotational atherectomy with balloon angioplasty in the prevention of restenosis of obstructed small coronary arteries. Methods A total of 446 patients with myocardial ischemia associated with an angiographic stenosis in a native coronary artery 2 to 3 mm in diameter and ≤20 mm in length without severe calcification were randomly assigned to receive rotational atherectomy (n = 227) or balloon angioplasty (n = 219). The primary end point was target vessel failure at 12 months (defined as the composite of death, Q-wave myocardial infarction, and clinically driven repeat revascularization of the target vessel). Results The mean reference vessel diameter was 2.46 ± 0.40 mm, the mean lesion length was 9.97 ± 5.59 mm, and the prevalence of diabetes mellitus was 32%. Acute procedural success (91.6% for rotational atherectomy, 94.1% for balloon angioplasty, P = .36) and target vessel failure at 12 months were not significantly different (30.5% vs 31.2%, P = .98). At 8 months, there were no significant differences in minimum lumen diameter (1.28 ± 0.63 mm vs 1.19 ± 0.54 mm, P = .26), percent diameter stenosis (28% ± 12% vs 29% 15%, P = .59), binary restenosis rate (50.5% vs 50.5%, P = 1.0), or late loss index (0.57 vs 0.62, P = .7). No Q-wave myocardial infarctions occurred in either arm of the study, and non-Q-wave myocardial infarctions (defined as creatine kinase level >2 times normal with an elevated creatine kinase-myocardial band isoenzyme level) occurred in 2.2% and 1.4% of the patients in the rotational atherectomy and balloon angioplasty groups, respectively (P = .72). Conclusion Rotational atherectomy was found to be safe in

关键词：血管成形术经腔经皮冠状动脉/方法斑块切除术冠状动脉/方法冠状动脉再狭窄/预防和控制冠状动脉再狭窄/放射摄影术冠状动脉狭窄/病理学冠状动脉狭窄/治疗双盲法随访研究治疗失败女(雌)性人类男(雄)性中年人

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