Angiographic Success Rate Research Articles

Success rates of percutaneous coronary intervention of chronic total occlusions and long-term survival in patients with diabetes mellitus

The objectives of this study were to evaluate angiographic and clinical outcomes among patients with diabetes mellitus (DM) who underwent percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO). We compared them with matched patients undergoing PCI of a non-CTO lesion. All patients had documented DM. Matching was performed using a propensity score for CTO. There were 506 patients with DM and CTO who were matched with a non-CTO group. Results showed that angiographic success rates were lower with CTO (75% vs. 93%, p<0.001). In-hospital major adverse cardiac event (MACE - death, urgent bypass surgery, Q-wave myocardial infarction or target vessel revascularisation) rates were equivalent (CTO 3.2% vs. non-CTO 2.6%, p=0.57). Survival was not different five years after revascularisation of CTO (75%) vs. non-CTO (79%) (p=0.20). In addition, when DM patients with CTO were analysed according to angiographic success of PCI, there were no significant differences in either in-hospital (success 1.6% vs. failure 2.4%, p=0.7) or 1-year mortality (success 22.2% vs. failure 26.8%, p=0.3). We conclude that PCI of CTO is safe in patients with DM. Angiographic failure is not associated with an increase in MACE rates or mortality as compared to matched non-CTO patients. However, there is not a measurable improvement in survival in this DM-CTO population.

Comparison of Early and Six Month Outcomes of Direct Stenting vs. Conventional Stenting in Patients with Angina Pectoris

Background and Objectives:Direct stenting (DS) has been shown to be safe and feasible, with demonstrable reductions in cost, procedural time and radiation exposure, and may also result in less vessel injury. The aim of this study was to compare the immediate and six month clinical and angiographic outcomes of direct stent (DS) with stent implantation implantation following balloon predilatation (conventional stenting, CS). Subjects and Methods:Between July 2001 and June 2004, 266 patients (293 lesions) with angina pectoris were included in this study. Patients having lesion characteristics with excessive calcification, left main lesion, chronic total occlusion, severe proximal tortuosity and a bifurcated lesion were excluded. Follow up angiography was performed about six months after the initial procedure. Results:Direct (73 lesions) and conventional stenting (220 lesions) were performed respectively. In the DS group, the minimal luminal diameter was larger (0.36±0.18 vs. 0.31±0.19 mm, p=0.036) and diameter stenosis lower than in the CS group (89.1±5.1 vs. 90.6±3.9%, p=0.026). However, no difference was found in the reference vessel diameter between the two groups. From the immediate angiographic results, the CS group showed a longer stent length than the DS group (18.84±5.61 vs. 16.16±3.67 mm, p=0.000), but the DS group had a higher balloon inflation pressure than the CS group (12.25±1.71 vs. 11.35±1.72 atm, p= 0.000). However, no difference was found in the post-stent minimal luminal diameter, acute gain and angiographic success rates. Follow up angiography was performed in 68.6% (201/293) of lesions. The angiographic restenosis rate was similar between the two groups (DS, 19.6 vs. CS, 19.3%, p=0.966), as were the other angiographic findings. The rates of in-hospital and 6 month follow up major adverse cardiovascular events (MACE) were similar between the two groups. Conclusion:Direct stenting showed similar rates of angiographic restenosis as well as inhospital and 6 months MACE (death, myocardial infarction, target lesion revascularization, cerebrovascular accident) compared with conventional stenting. (Korean Circulation J 2006;36:214-220)

Clinical and Angiographic Analysis With a Cobalt Alloy Coronary Stent (Driver) in Stable and Unstable Angina Pectoris

The Clinical and Angiographic analysis with a Cobalt Alloy Coronary Stent (Driver) (CLASS) study was a prospective, nonrandomized, multicenter study designed to assess the safety and efficacy of a cobalt-chromium alloy-based stent in patients with stable or unstable angina pectoris. A total of 203 lesions were treated in 202 enrolled patients. The percentage of major adverse cardiac event-free patients was 87.6% (177 of 202) at 6 months (primary safety end point; major adverse cardiac events were defined as death, myocardial infarction, emergency bypass surgery, or target lesion revascularization [percutaneous transluminal coronary angioplasty or coronary artery bypass grafting]). The angiographic success rate (primary efficacy end point) was 100%, and the procedural success rate was 98%. The binary in-stent restenosis rate at 6 months was 12.6%. Our results have demonstrated that the Driver cobalt-chromium alloy stent can be used with a low 6-month incidence of major adverse cardiac events, a low 6-month binary restenosis rate, and high angiographic and procedural success rates.

Long‐Term Outcome After Coronary Angioplasty in Renal Transplant and Hemodialysis Patients

In order to determine how renal transplantation modifies in hospital and long-term outcome after coronary angioplasty, we compared dialysis and renal transplant patients with control patients without renal failure. Seventy-five consecutive dialysis patients (group D) and 37 renal transplant patients (group T) undergoing coronary angioplasty, were compared with two control groups (groups control D and control T, respectively) matched 1:1 with groups D and T for clinical and angiographic characteristics. The mean follow-up was 50 months. The rate of angiographic success was high and comparable in the four groups (P=0.7). Renal transplant patients were younger than dialysis non-transplant patients (P=0.004). The risk of 4-year cardiac death and nonfatal myocardial infarction was higher in dialysis compared to control dialysis patients (OR 2.6, 95% CI 1.35--5.01, P=0.004), in transplant patients compared to control transplant patients (OR 9.93, 95% CI 1.17--84.04, P=0.03), and there was a trend toward a higher risk in dialysis than in renal transplant patients (OR 1.6, 95% CI 0.8--3.19, P=0.08). The risk of 4-year mortality was higher in dialysis patients than in the other three groups (31% in group D versus 19% in group T, 13% in group control D, and 0% in group control T, P<0.001). After adjusting for age, diabetes, and multivessel disease, long-term mortality risk was similar in dialysis and renal transplant patients. On multivariate analysis, renal function (P=0.002), age (P=0.005), and tobacco consumption (P=0.005) were independently associated with 4-year cardiac death. In patients with end-stage renal disease who undergo coronary angioplasty, renal transplantation was not independently associated with a lower long-term mortality compared to dialysis treatment. Both dialysis and renal transplant patients show lower survival rates compared to matched control patients.

Diabetic Nephropathy, Percutaneous Coronary Interventions, and Blockade of the Renin-Angiotensin System

Since recent studies demonstrated an impaired outcome after percutaneous coronary interventions (PCI) in patients with chronic renal failure but did not address the aetiology of renal failure, we now analysed the outcome of patients with diabetic nephropathy in 721 consecutive patients undergoing PCI. Diabetic nephropathy was present in 37 patients (5.1%), and diabetes alone in 126 patients (17.5%); 178 patients (24.7%) suffered from renal insufficiency of other causes; the other 380 patients (52.7%) were used as controls. Although angiographic success rates were similar in the subgroups (94–97%), 30-day and long-term mortality after 4 years was significantly higher in patients with diabetic nephropathy (8.1 and 27%, respectively) than in diabetics (1.6 and 8.7%, respectively), patients with renal insufficiency (3.9 and 16.8%, respectively), or controls (2.4 and 5.0%, respectively, each p < 0.001, log-rank test). Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a marked decrease in 2-year mortality in patients with diabetic nephropathy (19.4 vs. 33.3%, respectively, p = 0.02, log-rank test).

Percutaneous coronary intervention in unprotected left main stem disease: the state of play

Percutaneous coronary intervention (PCI) to the left main coronary artery (LM) presents important technical challenges that are both lesion and site specific. Available technology has improved and so has our...

Usefulness of noncoronary vascular disease in predicting adverse events in the year following percutaneous coronary intervention

It is unknown whether noncoronary vascular disease is associated with persistent cardiac risk in patients who undergo percutaneous coronary intervention (PCI). Using the National Heart, Lung, and Blood Institute Dynamic Registry, the incidence of death, myocardial infarction (MI), and repeat revascularization outcomes were compared in patients who had noncoronary vascular disease (n = 554) with patients who did not (n = 4,075). Vascular disease was defined as a history of stroke, transient ischemic attack, claudication, vascular bypass, limb amputation, or aortic aneurysm. Patients who had concomitant noncoronary vascular disease had more significant co-morbidities. Angiographic success rate was lower in patients who had concomitant noncoronary vascular disease (89.5% vs 93.2%, p <0.01), whereas in-hospital adverse events, including death (2.7% vs 1.3%, p <0.05), MI (4.7% vs 2.6%, p <0.01), stroke (1.1% vs 0.2%, p <0.001), major entry site complication (6.7% vs 3.5%, p <0.001), and need for coronary artery bypass grafting (2.2% vs 1.1%, p <0.05) were significantly higher. One-year death rate (10.5% vs 4.5%, p <0.001) and MI rate (9.2% vs 5.2%, p <0.001) were also significantly higher in patients who had vascular disease. After adjustment, vascular disease was independently associated with a higher risk of death or MI (risk ratio 1.4, 95% confidence interval 1.1 to 1.8) and death, MI, or coronary artery bypass grafting (risk ratio 1.3, 95% confidence interval 1.1 to 1.6) at 1 year. Repeat PCI rates were similar (15.9% vs 13.8%, p = NS). In conclusion, the presence of noncoronary vascular disease is an independent predictor of MI and death or MI 1 year after PCI. Because PCI is often performed before vascular surgery, these data may lend insight to the risk/benefit ratio of such an approach.

Outcome of Endovascular Treatment in Symptomatic Intracranial Vascular Stenosis

ObjectiveThe outcome evaluation for the revascularization of intracranial vascular stenoses has not been fully described due to the highly technical nature of the procedure. We report here on the early and late clinical outcomes of angioplasty and/or stenting of symptomatic severe intracranial vascular stenoses at a single institute.Materials and MethodsSince 1995, we have treated 35 patients with symptomatic intracranial vascular stenosis (more than 70% stenosis, mean stenosis: 78.6% ± 6.2%). Angioplasty (n = 19) was performed for the horizontal segment of the middle cerebral artery (M1) (n = 16) and the basilar artery (BA) (n = 1), the intradural vertebral artery (VA) (n = 1), and the cavernous internal carotid artery (ICA) (n = 1). Stenting (n = 16) was performed for the cavernous or petrous ICAs (n = 9), the intradural VA (n = 3), BA (n = 2), and M1 (n = 2) artery. We assessed the angiographic success (defined as residual stenosis < 50%) rate, the periprocedural complications during the 30-day periprocedural period, the symptomatic recurrence and restenosis during a mean 22-month follow-up (FU) period. The Kaplan-Meier estimate of the cumulative event-free rate of the major cerebrovascular events, i.e. death, stroke or restenosis, was also done.ResultsAngiographic success was achieved in 97% of our patients (34/35). There were four procedure-related complications (11%) including a death and a minor stroke. During the mean 22-month FU, the asymptomatic restenosis rate was 9% and the symptomatic restenosis rate was 6% in the target lesion and 9% in all the vascular territories. The Kaplan-Meier estimate was 70.6% (95% confidence interval = 46.5-94.7) after 33 months of FU.ConclusionIn addition to a high angiographic success rate and an acceptable periprocedural complication rate, intracranial angioplasty and/or stenting revealed a relatively low symptomatic recurrence rate. Hemorrhage is a rare, but the physician must aware that potentially fatal periprocedural complications can occur.

Efficacy of Thrombosuction using the Export Aspiration Catheter before Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

Background and Objectives:Effective myocardial reperfusion following primary percutaneous coronary intervention for AMI, in lesions with a thrombus, is limited by distal embolization and slow/no reflow phenomenon. We evaluated the safety and efficacy of a thrombus reduction technique, using the export aspiration catheter for thrombosuction prior to primary PCI for AMI. Subjects and Methods:We analyzed 61 AMI patients who had a thrombus burden on angiography, after having undergone primary PCI, either with or without EAC (EAC group; n=31, 24 males, mean ages 54.7±11.8 years)(control group; n=31, 20 males, mean ages 65.5±12.2 years). After the primary PCI, the angiographic findings and clinical outcomes at 1 and 6 months were recorded. Results:The procedural and angiographic success rates were 100 (31/31) and 93.5 (29/31), and 100 (31/31) and 87.1% (27/31), respectively. After PCI, the recovery rate to TIMI 3 flow was higher in the EAC than the control group (26/31 vs. 20/31, p<0.05), and the corrected TIMI frame count was less in the EAC than the control group (23.9±15.1 vs. 34.8±22.5, p<0.05). However, there were no different in the TIMI perfusion grade between the two groups. Although there was no statistical significance, distal embolization was more commonly observed in control (16.1%, 5/31) than the EAC group (0/31)(p=0.056). There were no differences in the incidences of MACE at 1 (0 vs. 7.7%, p=0.237) and 6 months (6.9 vs. 0%, p=0.500) between two groups. In the 31 patients who underwent successful thrombosuction, gross thrombi were obtained from 25 (80.6%). Conclusion:In AMI, the use of thrombosuction, with EAC prior to PCI, provides a simple, rapid and potentially effective method for removal of the thrombus burden and restoration of coronary flow. (Korean Circulation J 2005;35:172-179)

Feasibility of Transradial Coronary Angiography Using a Single Judkins Left Catheter

Background and Objectives:Transradial coronary angiography and intervention are getting more popularity throughout the world because of lower incidence of puncture site complications and the patients have displayed early ambulation. However, radial arterial spasms and possible endothelial injury due to the small size of radial artery are troublesome. To overcome this problem, we investigated the usefulness of performing transradial coronary angiography using a single Judkins left catheter (JL). Subjects and Methods:A total of 268 patients who underwent right transradial coronary angiography from June 2003 to December 2003 were enrolled for this prospective study. The Judkins Left 3.5(JL3.5), the Multipurpose (MP) and Amplatz Left (AL2 for males, AL1 for females) were assigned to be used in patients with a randomized protocol. The technical/angiographic success rate, procedural/fluoroscopic time and the frequency of stiffwire usage were assessed. Results:Technical success was accomplished in 87 (96.7%) of the patients with a single JL3.5, in 90 (97.8%) of the patients with the MP and in 83 (96.5%) of the patients with the AL catheter. Successful angiography success was achieved in 77 (85.6%) of the patients using the JL3.5, in 71 (77.2%) of the patients using the MP and in 66 patients (76.7%) using the AL. The technical success rate (p=0.270) and the angiographic success rate (p= 0.162) showed no significant difference among the three catheters. The procedural time was 8.1±4.0 min in the JL3.5 group, 8.1±3.7 min in the MP group and 7.3±3.4 min in the AL group, respectively (p=0.431). Also, the fluoroscopic time was not different among the three groups. Conclusion:The JL3.5 catheter is an excellent tool for both coronary imaging and it is equally successful as compared with the MP and AL catheters. Therefore, the JL3.5 may be considered as the initial catheter that can be used, including for those difficult cases having tortuous vasculature of the subclavian artery and the ascending aorta, during transradial coronary angiography. (Korean Circulation J 2005;35:253-257)

Chronic total occlusions (CTO) in the field of Percutaneous Coronary interventions (PCI) is a challenge- the result of initial 25 cases.

With an aim to investigate the success rate &amp; immediate clinical outcome of Percutaneous Coronary intervention (PCI) for chronic total occlusion (CTO). we analyzed PCI of 150 cases. This is an on going study started from April 2002 to till date. The technique of PCI involving CTO has improved over time. However limited data on acute &amp; follow up result in patients treated with PCI on CTO in recent years are available. Our of 150 cases of PCI, 25 patients were of CTO of &gt; 30 days of duration. The result of their PCI were evaluated. The age range of the Pts were 50±10 yr; with male female ratio of 5:1 Diagnosis of the Pts were old myocardial infarction with Post MI angina 20 cases, Chronic stable angina 5 cases. Single vessel disease was 20 cases &amp; Double vessel disease was 5 cases. Angiographic success rate was 20 cases (80%), Procedural success 19 cases (76%), Clinical success 18 cases (70%).

Evaluation of the Medtronic (Driver) cobalt-chromium alloy coronary stent system

The Driver Registry was a prospective, multicenter, nonrandomized study to evaluate the clinical safety and efficacy of the Driver cobalt-chromium alloy stent. Use of the cobalt-chromium alloy in place of stainless steel offers enhanced visibility and radial strength with thinner structural elements. The registry enrolled 298 patients with symptomatic ischemic heart disease attributable to de novo or restenotic nonstented native lesions of a single vessel amenable to percutaneous stenting. The primary composite end point was the incidence of major adverse cardiac events (death, myocardial infarction, emergency bypass surgery, or target lesion revascularization) 180 days after enrollment. Quantitative coronary angiography was performed before and after the index stent deployment and repeated at 6 months in 83 patients. Mean patient age was 62.6 years, mean reference vessel diameter was 3.07 mm before the procedure, and mean lesion length was 11.04 mm. Fifty-one patients received multiple stents. Angiographic success rate was 100% and procedural success rate was 98.3%. Cumulative incidence of major adverse cardiac events was 5.7% and target lesion revascularization was 3.4% at 180 days. In-stent late loss was 0.94 mm at 180 days, and no subacute stent thromboses were observed. This registry demonstrated the safety and efficacy of this novel coronary stent platform.

Stent implantation in very small coronary arteries: The Tsunami SV international registry

The aim of this multicenter registry was to examine the in-hospital and long-term clinical outcomes of patients who underwent Tsunami SV stent implantation for the treatment of lesions involving coronary arteries with a reference diameter of <2.5 mm. The angiographic success rate was 97.5%. No in-hospital or 30-day major adverse cardiac events occurred. During the 6-month follow-up, there was 1 cardiac death (1%), and 5 subjects (4.8%) underwent repeat target lesion revascularization.

Cutting balloon angioplasty vs. conventional balloon angioplasty in patients receiving intracoronary brachytherapy for the treatment of in‐stent restenosis

The objective of this study was to evaluate the safety and efficacy of cutting balloon angioplasty (CBA) for the treatment of in-stent restenosis prior to intracoronary brachytherapy (ICB). Cutting balloon angioplasty may reduce the incidence of uncontrolled dissection requiring adjunctive stenting and may limit "melon seeding" and geographic miss in patients with in-stent restenosis who are subsequently treated with ICB. We performed a retrospective case-control analysis of 134 consecutive patients with in-stent restenosis who were treated with ICB preceded by either CBA or conventional balloon angioplasty. We identified 44 patients who underwent CBA and ICB, and 90 control patients who underwent conventional percutaneous transluminal coronary angioplasty (PTCA) and ICB for the treatment of in-stent restenosis. Adjunctive coronary stenting was performed in 13 patients (29.5%) in the CBA/ICB group and 41 patients (45.6%; P < 0.001) in the PTCA/ICB group. There was no difference in the injury length or active treatment (ICB) length. The procedural and angiographic success rates were similar in both groups. There were no statistically significant differences in the incidence of death, myocardial infarction, recurrent angina pectoris, subsequent target lumen revascularization, or the composite endpoint of all four clinical outcomes (P > 0.05). Despite sound theoretical reasons why CBA may be better than conventional balloon angioplasty for treatment of in-stent restenosis with ICB, and despite a reduction in the need for adjunctive coronary stenting, we were unable to identify differences in clinical outcome.

Effectiveness of primary angioplasty for acute myocardial infarction in patients on dialysis

We sought to characterize the outcome in patients who were on long-term dialysis and who underwent primary percutaneous trnasluminal coronary angioplasty (PTCA) for acute myocardial infarction. Of 2,831 consecutive patients who underwent primary PTCA for acute myocardial infarction from 1993 to 2001, 15 patients on long-term dialysis were identified. This small cohort had a 40% incidence of cardiogenic shock on admission. Despite the angiographic success rate for primary PTCA of 80%, in-hospital mortality was 53%.

Procedural results and distal embolization after saphenous vein graft stenting and angioplasty for in-stent restenosis of grafts.

Saphenous vein graft (SVG) angioplasty is associated with frequent periprocedural complications due to distal embolization and a high risk of restenosis. The purpose of this single-center, retrospective study was to determine the distal embolization incidences and outcomes of stenting for SVG lesions and percutaneous angioplasty for in-stent restenosis of these SVGs. We studied 48 consecutive patients (mean age, 62 +/- 7 years, 92% men) who had prior CABG and underwent stent deployment to SVG lesions detected at our institution over a period of 4 years. Mean lesion length was 12.4 +/- 3.2 mm. The minimal lumen diameter increased from 0.7 +/- 0.3 mm to 3.2 +/- 0.4 mm after stenting. Distal embolization as no reflow/slow flow phenomenon occurred in 5 (10%) patients. Angiographic success was achieved in 98% of the patients. Procedural success was achieved in 96% of the patients. No reflow/slow flow phenomenon was observed, particularly in patients with acute coronary syndrome. During the follow-up, 11 patients (23%) had angiographic evidence of restenosis. Lesions were treated with balloon angioplasty and the minimal lumen diameter increased from 2.6 +/- 1.1 mm to 3.1 +/- 0.3 mm. The angiographic and procedural success rates were both 100%. There were no cases of "no" reflow/slow flow. Restenosis was particularly frequent in patients with diabetes mellitus, hypercholesterolemia, and acute coronary syndrome. Stent implantation in patients with de novo SVG lesions can be achieved with a high rate of angiographic and procedural success. The distal embolization risk is lower during angioplasty of in-stent restenosis lesions of SVGs compared to de novo SVG lesions.

The Long-Term Clinical Outcomes of Primary PTCA with Heparin-Coated Stent in Acute Myocardial Infarction

Background and Objectives:Primary percutaneous coronary intervention (PCI) has been reported to be effective reperfusion therapy for acute myocardial infarction (AMI). In the very thrombotic environment of AMI, primary PCI, with heparin-coated stents, has been known to reduce the early reocclusion of the stented vessel by preventing thrombosis. However, little data exist regarding the long-term clinical outcomes. The aim of our study was to evaluate the safety, feasibility and long-term efficacy of heparin-coated stents in AMI. Subjects and Methods:Between January 1998 and July 2002, primary PCI with heparin-coated stents was performed in 132 consecutive patients (98 males, with a mean age of 56.3±10.7 years) admitted with the diagnosis of AMI within 12 hours from the onset of the chest pain. Major adverse cardiac events (MACE), including death, MI, TLR (target lesion revascularization) and CABG, were recorded during hospitalization and the follow-up period. Angiograms were obtained at the baseline, after stent implantation and at 6 months following implantation. Results:The angiographic and procedure success rate was 96.2%. During hospitalization, there was no evidence of reocclusion of stented vessel, but 1 patient underwent a repeat PCI due to dissection. There were no bleeding complications. A six-month angiographic follow-up was completed in 47.2% of eligible patients and binary restenosis was present in 20.1%. During the long-term clinical followup (mean follow-up period 37.2±17.2 months), there were 12 deaths, 1 myocardial infarction and 18 TLR. The MACE free survival rate was 76.5%. Conclusion:Primary PCI, with heparin-coated stents, shows favorable long-term clinical outcomes. (Korean Circulation J 2004;34(6):540-547)

Ethnic differences in the presentation, treatment strategy, and outcomes of percutaneous coronary intervention (a report from the National Heart, Lung, and Blood Institute Dynamic Registry)

Information about the impact of race/ethnicity on adverse outcomes after percutaneous coronary intervention (PCI) in the modern era is limited. Using consecutive patients from the National Heart, Lung, and Blood Institute Dynamic Registry, this study investigated differences in clinical presentation, treatment strategy, and acute and long-term outcomes in 3,669 white, 446 black, 301 Hispanic, and 201 Asian patients who underwent PCI. All comparisons were made to whites. Blacks were more likely than whites to be younger, women, and to present with a higher prevalence of cardiovascular risk factors (hypertension, diabetes, and smoking). Hispanics tended to be younger, hypertensive, diabetic, and to be undergoing their first cardiovascular procedure. Asians were, on average, younger, men, and presented more often with hypertension and diabetes than whites. Although the rate of stent implantation was significantly lower in blacks compared with whites (63% vs 74%, p <0.001), angiographic and procedural success rates were high (≥95%) and did not differ by race/ethnicity. In-hospital mortality (0.2% vs 1.7%, p <0.05) and death/myocardial infarction (MI)/coronary artery bypass grafting (CABG) (3.1% vs 5.5%, p <0.05) were lower in blacks. All other in-hospital complications were similar to whites. At 1 year, there were no statistical differences in cumulative adverse event rates by ethnicity; however by 2 years there was a modestly higher mortality rate (adjusted RR 1.87; 95% confidence interval 1.15 to 3.04) and adverse event rate (death/MI, death/MI/CABG) among black patients. Thus, although differences in patient demographics, clinical presentation, angiographic characteristics and treatment strategies did not impact the incidence of acute and 1-year adverse outcomes of non-whites, there appears to be a significant reduction in event-free survival among blacks by 2 years.

Comparison of short- and long-term outcomes of coronary angioplasty in patients with and without diabetes mellitus and with and without hemodialysis

In-hospital and long-term outcomes after coronary angioplasty in 28 dialysis diabetic and 84 dialysis nondiabetic patients were compared with clinical outcomes after coronary angioplasty in 28 nondialysis diabetic and 84 nondialysis, nondiabetic patients matched according to clinical and angiographic characteristics. The rate of angiographic success in diabetic dialysis patients was high and similar in the 4 groups. The risk of 4-year cardiac death and nonfatal myocardial infarction was higher in dialysis diabetics than in dialysis nondiabetics (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.01 to 2.75, p <0.05), nondialysis diabetics (OR 4.27, 95% CI 2.87 to 5.67, p <0.008), and nondialysis nondiabetics (OR 5.2, 95% CI 4.17 to 6.23, p <0.0001).

Predictors of early and late outcome of percutaneous coronary intervention in octogenarians

Objective — To evaluate the short and long-term results of percutaneous coronary interventions (PCI) in patients aged 80 years or older and to identify predictors of event-free survival.Methods and results — Clinical and angiographic data from all patients undergoing percutaneous coronary intervention in our institution are prospectively collected and stored in a computerized database. The clinical and angiographic characteristics of all patients aged 80 years or older undergoing percutaneous coronary intervention between January 1994 and December 1999 were analysed retrospectively. Follow-up was obtained by interview or through the referring physician. One hundred and fifty-eight patients aged 80 years or older (median: 83.4; range: 80.2-92.2) underwent percutaneous coronary intervention in our institution during the study period.The initial angiographic success rate was 92%. In-hospital mortality was 8.2% and procedural success 84.8%. One-year and two-year survival were 81% and 72.2% respectively, while event free survival at 1 year and 2 years was 65.8% and 57%. Using the Cox proportional hazards method, we identified incomplete revascularization and low left ventricular ejection fraction (LVEF) as predictors of death at 2 years. Complete revascularization and stenting were independent predictors of 2-year event-free survival.Conclusion — Percutaneous coronary intervention can be performed safely in octogenarians. Complete revascularization, stenting and preserved left ventricular ejection fraction were independent predictors of better outcome in this population.