Abstract
Percutaneous coronary revascularization (PCR) with polymer-coated drug-eluting stents (DES) or bare-metal stents (BMS) is considered the standard therapy in advanced ischemic heart disease (IHD). Despite revascularisation, many of these patients subsequently develop heart failure with reduced ejection fraction (HFrEF). We analysed 51 patients with IHD, treated by PCR and insertion of DES and/or BMS who later developed HFrEF. Patients with DES where more likely women, of younger age and a higher incidence of diabetes mellitus compared to patients with BMS who were generally men, of older age and had more frequently acute ST-elevation myocardial infarction (STEMI) as indication for PCR. Although patients with DES had more severe IHD, their EF was higher, possibly due to the benefits offered by the DES.
Highlights
Ischaemic heart disease (IHD) represents the most common cause of death and of heart failure with reduced ejection fraction (HFrEF) in the developed world [1]
All fifty-five patients included in our study had angiographically confirmed IHD and underwent one or more Percutaneous coronary revascularization (PCR) with implantation of at least one stent
The main indications for PCR and stenting, associated diseases and risk factors, in both groups are illustrated in table 2 and the results of clinical and echocardiographic evaluations are presented in table 3
Summary
Ischaemic heart disease (IHD) represents the most common cause of death and of HFrEF in the developed world [1]. CABG is recommended over PCR for younger patients, with multivessel IHD and severely reduced LV function [1]. This procedure is associated with an increased perioperative risk. PCR involves a much lower risk and the development of more performant DES, treated with immunosuppressive and antiproliferative drugs, with an advanced polymer coating, could improve the evolution of these patients [4]. DES consist of three parts - the stent platform, the polymer coating that binds the drug to the stent and releases drug and the drug with immunosuppressive and antiproliferative effects (paclitaxel, sirolimus and everolimus) which inhibits neointimal growth that would cause restenosis [4], Polymers selected to be used as a drug carrier should share following features: be biocompatible; do not interact with the drug; provide a platform for appropriate drug-eluting kinetics; behave biologically inert after the drug has been
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