Multiple Coronary Artery Lesions Research Articles

Analysis of influential factors of stent-related adverse events after percutaneous coronary intervention more than twice: a single-center retrospective study.

We aimed to assess the factors affecting patient outcomes in multiple stent placements over a 10-year period. The single-center study included 1,200 patients who had multiple stents implanted at least twice or more. Participants were divided into the adverse outcomes as endpoints (n = 204 [17%]) and control groups. Univariate and multivariate analyses of stent-related adverse events risk during 10 years and logistic regression analysis of the adverse outcomes risk factors were performed. Univariate analysis revealed the impact of acute coronary syndrome (ACS), diabetes mellitus, hypertriglyceridemia, cumulative lesions in the left anterior descending (LAD) and left circumflex (LCX) arteries, number of stents in the LAD, LCX, and right coronary artery (RCA), presence of multiple coronary artery lesions, total number of stents used, and intervals between the first and second and between the fourth and fifth implantations. For secondary stent implantation, significant factors in univariate analysis included the number of LAD and LCX lesions, stents in LAD, LCX, and RCA, extent of coronary lesions, ACS, hypertension, diabetes, and total stent count. Many factors affect the outcomes in this patient group over time. Reducing the need for frequent percutaneous coronary intervention and considering the number of stents implanted are essential to improving outcomes.

Impact of risk factors on intervened and non-intervened coronary lesions.

In-stent restenosis (ISR) and aggravated non-intervened coronary lesions (ANL) are two pivotal aspects of disease progression in patients with coronary artery disease (CAD). Established risk factors for both include hyperlipidemia, hypertension, diabetes, chronic kidney disease, and smoking. However, there is limited research on the comparative risk factors for the progression of these two aspects of progression. The aim of this study was to analyze and compare the different impacts of identical risk factors on ISR and ANL. This study enrolled a total of 510 patients with multiple coronary artery lesions who underwent repeated coronary angiography (CAG). All patients had previously undergone percutaneous coronary intervention (PCI) and presented non-intervened coronary lesions in addition to the previously intervened vessels. After data analysis, it was determined that HbA1c (OR 1.229, 95% CI 1.022-1.477, P=0.028) and UA (OR 1.003, 95% CI 1.000-1.005, P=0.024) were identified as independent risk factors for ISR. Furthermore, HbA1c (OR 1.215, 95% CI 1.010-1.460, P=0.039), Scr (OR 1.007, 95% CI 1.003-1.017, P=0.009), and ApoB (OR 1.017, 95% CI 1.006-1.029, P=0.004) were identified as independent risk factors for ANL. The distribution of multiple blood lipid levels differed between the ANL only group and the ISR only group. Non-HDL-C (2.17 mmol/L vs. 2.44 mmol/L, P=0.007) and ApoB (63.5 mg/dL vs. 71.0 mg/dL, P=0.011) exhibited significantly higher values in the ANL only group compared to the ISR only group. Blood glucose levels and chronic kidney disease were identified as independent risk factors for both ISR and ANL, while elevated lipid levels were only significantly associated with ANL. In patients with non-intervened coronary lesions following PCI, it is crucial to assess the concentration of non-HDL-C and ApoB as they serve as significant risk factors.

The Effect and Possible Mechanism of Cardiac Rehabilitation in Partial Revascularization Performed on Multiple Coronary Artery Lesions.

To observe the effect of cardiac rehabilitation (CR) in patients with partial revascularization performed on multiple coronary artery lesions and explore its possible mechanism. A total of 400 patients with multiple coronary artery lesions were enrolled and randomly divided into a complete revascularization group and a CR group, with 200 cases in each group. Target lesion revascularization was performed radically in the complete revascularization group, while it was partially completed in the CR group, and postoperative CR was performed. All the patients were put under conventional treatment. Left ventricular end diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), 6-minute walking distance (6-MWD), quality-of-life scores, safety and levels of serum nitric oxide (NO), nitric oxide synthase (NOS), superoxide dismutase (SOD), and vascular endothelial growth factor (VEGF) were evaluated and compared between two groups before and after training. There was no significant difference in LVEDD, LVEF, 6-MWD, quality-of-life scores, levels of serum NO, NOS, SOD, and VEGF between two groups before training (p>0.05). 1 year later, compared with the complete revascularization group, the occurrence of major adverse events in the CR group declined (p>0.05); the measurements of LVEDD decreased and LVEF increased (p>0.05), 6-MWD increased significantly (p<0.05), quality-of-life scores were higher (p<0.05), the levels of serum NO, NOS, and SOD increased noticeably, and the levels of serum VEGF decreased significantly in the CR group (p<0.05). There were significant differences within the same group, before and after training (p<0.05). Cardiac rehabilitation training, not increase in the incidence of adverse events, is effective and safe after partial revascularization in patients with multiple coronary artery lesions, which has notable clinical advantages in promoting patients' exercise endurance and quality-of-life by improving the nitric oxide synthase system and antioxidant system and reducing the level of VEGF.

PS-BPR02-9: RECURRENCE OF RENAL ARTERY STENOSIS BY PONATINIB, A MULTI-TARGETED TYROSINE-KINASE INHIBITOR

Introduction: Cardiovascular disease and drug induced hypertension have been reported with tyrosine-kinase inhibitor including ponatinib treatment in chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). We report bilateral renal artery stenosis (RAS) in a patient who had received ponatinib for relapsing Ph+ALL after 2nd allogeneic stem cell transplantation. Case: A patient was a 40-year-old woman with no history of cardiovascular disease and hypertension. She developed myocardial damage that appeared to be ponatinib -induced, and catheterization of the heart revealed multiple coronary artery lesions and started optical medical therapy. 16 months after ponatinib treatment, she was referred to the nephrology department for evaluation of hypertension and increase in serum creatinine from 1.47 to 2.02 mg/dL. Renal ultrasonography and MRI revealed significant stenosis of the right renal artery, and angiography and stenting were performed. 5 months after the stent treatment, progression of renal dysfunction due to exacerbated RAS was observed. Intravascular ultrasonography revealed diffuse intimal thickening occurred in-stent restenosis, and balloon dilation was performed. She required balloon dilatation a total of three times even after the discontinuation of ponatinib treatment. The patient was thought to have systemic vascular endothelial damage caused by ponatinib. Discussion: It should be considered when hypertension and renal dysfunction occurs after ponatinib use

Predictors of pacemaker implantation in patients with myocardial infarction and heart block

The aim of the study was to identify predictors of early and delayed pacemaker (PM) implantation in patients with myocardial infarction (MI) and heart block, allowing the development of models for predicting the feasibility of its implantation.Methods. A randomized selection method was used to form a cohort of patients with MI complicated by cardiac conduction disorders. The first (control) group included 72 patients who did not have a PM implanted, the second (n=46) and third (n=68) groups consisted of patients with MI, having, respectively, indications for early (in the acute period of MI) and delayed (average after 3 years) PM implantation. All patients underwent endovascular revascularization of the infarct-dependent artery during hospitalization. Demographic, clinical, and morphological predictors of PM implantation in patients of the second and third groups were evaluated in comparison with the control group. Multiple logistic regression was used to identify factors associated with the need for PM implantation in the short term (hospital period) and in the long-term period.Results. Factors that determine the expediency of a permanent PM in the acute period of MI at the hospital stage, delayed pacemaker implantation 3.2±1.9 years after myocardial infarction, as well as predictors that do not require a permanent PM throughout the entire observation period, were identified. The main factors that require permanent PM implantation in the acute period were identified: 3rd degree atrioventricular (AV) block in NSTEMI, GRACE score 96 or higher, development of 3rd degree AV block in MI of any localization except postero-inferior. Predictors for the need for PM implantation after 3.2±1.9 years (delayed period) were STEMI of anterior localization; at the same time, age had an inversely proportional relationship in predicting the fact of permanent pacing. The factors that determine the need for PM implantation are the presence of anterior MI, the multiple coronary artery lesions.Conclusion. In the acute (hospital) period of NSTEMI, PM implantation is indicated at a high risk of adverse cardiovascular complications (GRACE scale of 96 points and above), in the presence of the 3rd degree AV block in any MI localization, except for the inferior one. Indications for permanent pacing 3.2±1.9 years after an acute coronary event are STEMI of anterior localization and multiple coronary artery lesions.

Đặc điểm tổn thương động mạch vành và thay đổi mức lọc cầu thận sau chụp hoặc can thiệp động mạch vành qua da ở bệnh nhân bệnh thận mạn

Introduction: Coronary artery disease is the leading cause of death in patients with chronic kidney disease. Despite many advances in diagnosis and treatment, percutaneous coronary intervention in patients with chronic kidney disease remains challenging.Objectives: (1) Describe clinical, subclinical and coronary artery lesions in patients with chronic kidney disease requiring percutaneous coronary angiography at the Vietnam Heart Institute. (2) Evaluation the changes in clinical, laboratory and glomerular filtration rate after coronary angiography or intervention in thesse patients.Subjects and methods: A descriptive prospective study of 59 chronic kidney disease patients assigned to take percutaneous coronary angiography with or without intervention at the Vietnam Heart Institute from August 2020 to October 2021. The study collected and analyzed information of clinical and laboratory characteristics, percutaneous coronary angiography results and changes in renal function after intervention. Result: The average SYNTAX score was 21,9 ± 13,0. Coronary artery lesions accounted for the majority of branches (84.8%), lesions of 1 branch (11.9%). The most common site of injury was the left anterior descending artery (88.1%) followed by the right coronary artery (71.2%) and the circumflex artery (50.8%). The culprit lesions were often complex, type B2 and type C were the most common types (76.2%), followed by type B1 (14.3%), type A (9.5%). The rate of chronic total occlusion was also quitehigh (25.4%), lesions at the bifurcation (25.4%) were less common in left coronary artery (13.6%). 17,3% of patients had complications of acute kidney injury after the intervention, of which the CKD 3 and CKD 4-5 group were accounted for 12.9% and 23.8% of the patients respectively. Of these, 3 patients had to undergo emergency dialysis after the intervention.Conclusion: Coronary artery lesions in patients with chronic kidney disease was often complicated, often with multiple coronary artery lesions and tended to be more severe with the decline of glomerular filtration rate. Percutaneous coronary intervention in patients with chronic kidney disease had safe results in terms of procedures, however, the rate of complications of acute kidney injury was quite high in patients with CKD.

Efficacy and Prediction Model Construction of Drug-Coated Balloon Combined with Cutting Balloon Angioplasty in the Treatment of Drug-Eluting Stent In-Stent Restenosis.

Objective To investigate the efficacy of drug-coated balloon (DCB) combined with cutting balloon angioplasty (CBA) in the treatment of drug-eluting stent in-stent restenosis (DES-ISR) and to construct a predictive model for the occurrence of DES-ISR. MethodsAccording to the criteria of diagnosis, inclusion, and exclusion, DES-ISR patients who were treated in the outpatient and inpatient departments of cardiovascular medicine of Second People's Hospital of Guangdong Province from July 2021 to December 2021 were included. A total of 72 cases were planned to be enrolled, including 36 cases in the control group and 36 cases in the experimental group. The control group was treated with DCB, and the experimental group was combined with CBA. The treatment success rate, coronary angiography results before and after surgery, and the incidence of major adverse cardiovascular events during the follow-up period were compared between the two groups. Seventy-two DES-ISR patients were divided into ISR group and 59 non-ISR patients were divided into non-ISR group. The clinical data of the two groups were compared to analyze the risk factors affecting the occurrence of DES-ISR, and the prediction model was established. Results The surgical success rate of the experimental group was 94.44% (34/36), which was higher than the 77.78% (28/36) of the control group (P < 0.05). The minimum lumen diameter (MLD) of the experimental group 6 months after operation was greater than that of the control group, the late lumen loss (LL) and lumen stenosis rate were higher than those in the control group, and the incidence of major adverse cardiovascular events was lower than that in the control group (P < 0.05). In the ISR group, the proportion of patients with abnormal BMI, smoking, hypertension, diabetes, and family history of coronary heart disease and multivessel coronary artery disease was higher than that in the non-ISR group, the degree of stenosis target lesion was higher than that in the non-ISR group, the diameter of target lesion and stent diameter were smaller than those in the non-ISR group, and the length of target lesion and stent length were longer than those in the non-ISR group; the number of stents was more than that in the non-ISR group (P < 0.05). Combined hypertension, multiple coronary artery lesions, stenosis target lesion degree ≥85.05%, and target lesion length ≥36.88 mm were risk factors for DES-ISR, and target lesion diameter ≥3.15 mm and stent diameter ≥3.15 mm were protective factors (P < 0.05). The prediction model of DES-ISR was obtained by multiple logistic regression analysis, P = 1[1 + e(2.281 + 3.321Xhypertension + 3.427Xumber of arterial lesions + 3.359Xstenosis target lesion degree − 3.143Xtarget lesion diameter + 0.650Xtarget lesion length − 10.159Xstent diameter)]. The Hosmer-Lemeshow test showed that Hosmer-Lemeshow χ2 = 0.925, P =0.413; the ROC curve analysis showed that the AUC of the prediction model for the occurrence of DES-ISR was 0.924, the SE value was 0.022, and the 95% CI was 0.880-0.967. Conclusion DCB combined with CBA has good clinical efficacy in the treatment of DES-ISR, which can reduce the rate of lumen stenosis and the incidence of adverse cardiovascular events. The prediction model established according to risk factors has high predictive value for the occurrence of DES-ISR.

One-year outcomes of novel BioMime Morph tapered stent in long and multiple coronary artery lesions.

Even with the immense progress achieved in the field of percutaneous coronary interventions (PCIs), treatment of diffuse long atherosclerotic coronary artery disease continues to remain a challenge for durable outcomes. The downstream reduction in diameter along the lesion length of a coronary artery may compel the cardiologist to use either 2 overlapping stents of different diameters or a single long stent leading to stent-vessel mismatch at the edges. Recently, Meril Life Sciences Pvt. Ltd., India, has introduced a long-tapered sirolimus-eluting stent (SES) system, BioMime Morph, which conforms to the normal tapered geometry of coronary arteries along with adequate lesion coverage. In this study, we aimed to provide real world experience regarding the safety and efficacy of the BioMime Morph SES over a follow-up of one year. This was a single center, retrospective study involving 172 participants who underwent PCI with the BioMime Morph SES. Mean length of the target lesion was 34.4±10.4 mm, and mean stent length was 53.2±8.7 mm. The most frequent revascularized vessel was the left anterior descending artery (LAD) in 97 lesions (54.4%). Major adverse cardiac events (MACE) (defined as a composite of target vessel myocardial infarction, target lesion revascularization, and death due to a cardiac cause) at 1, 6, and 12 months were seen in 4 (2.3%), 7 (4.0%), and 8 (4.7%) patients, respectively. Overall, 5 cardiac deaths and 2 definite stent thrombosis were observed in the study. The study suggests that the novel BioMime Morph SES is an effective and a safe option for PCI in the treatment of long diffuse atherosclerotic lesions.

Early results of multiple coronary artery bypass grafting on arteries less than 1.5 mm in diameter

Abstract The widespread using of coronary artery (CA) stenting has led to the fact that nowadays coronary artery bypass grafting (CABG) is the method of choice for patients with multiple occlusions and diffuse lesions, who can be refused in surgery due to “small”, not specified in the guidelines, CA (diameter less than 1.5 mm). The use of microsurgical technique makes it possible to reconstruct small-caliber vessels, however, no detailed comparative data has been published yet. Aim To analyze the efficacy of CABG using microsurgical techniques for multiple CA bypass with arteries less than 1.5 mm and compare the results with coronary surgery of larger vessels in the early postoperative period. Methods We studied the early results of CABG in two groups of patients. The study group was represented by 100 patients with multiple coronary artery lesions with d&amp;lt;1.5 mm, who underwent control MSCT-shuntography in the postoperative period. We formed a control group of 100 patients who underwent CABG with a target artery d&amp;gt;1.5 mm. In all cases cardiopulmonary bypass and microsurgical technique were used. Results All patients underwent complete revascularization of CA, the average number of distal anastomoses was 4,3±0,5 in the study group versus 3.6±0,3 in the comparison group, p&amp;lt;0,001. Intraoperatively in the study group significantly more often performed complex anastomoses to arteries &amp;lt;1,5mm (47 patients vs 18, p&amp;lt;0,001), onlay-flap anastomoses (23 vs 1, p&amp;lt;0,001), single and multiple endarterectomies (19 vs 1, p&amp;lt;0,001). The need for long-term inotropic support (15 cases vs 13, p=0,684), as well as prolonged artificial lung ventilation (2 vs 3, p=0,651), in hospital stage was similar in both groups. Patients from the study group more often underwent reexploration for bleeding in the early postoperative period, which was explained by a large number of complex reconstructions and prolonged on pump time, nevertheless, the difference did not reach statistical significance (4 vs 2, p=0,407). Perioperative myocardial infarction (MI) were registered in 3 (3%) and 1 (1%) cases in the study and control groups, respectively, p=0,621. All patients in the study group underwent MSCT-shuntography in the early postoperative period, according to which 8 patients (8%) had occlusion of the autovenous coronary grafts to the CA&amp;lt;1.5mm and 4 patients (4%) - occlusion of the bypasses to CA&amp;gt;1.5 mm. Conclusion CABG in patients with coronary arteries less than 1.5 mm in diameter requires complex reconstructive techniques significantly more often. Nevertheless, in the early postoperative period, it is possible to achieve comparable results in the patient groups with and without CA&amp;lt;1,5mm in the anastomotic sites. Funding Acknowledgement Type of funding sources: None.

Myocardial revascularization in patients with coronary heart disease and type 2 diabetes

The review discusses myocardial revascularization in patients with coronary heart disease and type 2 diabetes. The data presented include findings from recent research and international and national recommendations and provides evidence on the advantages of coronary artery bypass surgery over percutaneous coronary intervention for patients with diabetes mellitus, stable coronary artery disease and multiple coronary artery lesions. Type 2 diabetes remains a significant predictor of adverse long-term outcomes of coronary artery bypass surgery. Therefore, we review studies showing that different strategies of coronary revascularization and preoperative preparation can affect the results of coronary intervention in patients with diabetes.

Characteristics of attenuated plaque in culprit lesions for acute coronary syndrome in elderly patients

Objective To explore the characteristics of attenuated plaque (AP) in culprit lesions for acute coronary syndrome (ACS) in elderly patients. Methods This study included 166 ACS patients meeting the conditions from Jan. 1, 2013 to Sep. 31, 2014. Clinical data, vascular lesions determined by coronary angiography and intravenous ultrasound (IVUS)-demonstrated characteristics of culprit plaque, which included presence of AP, maximum attenuation arc, extravascular elastic membrane area, lumen area, plaque area, plaque burden and remodeling index, were recorded. Results Compared with non-elderly group, elderly group had a higher proportion of multiple coronary-artery lesions (50.0% vs. 35.1%, χ2=6.525, P=0.038), more attenuation plaques (62.0% vs. 45.9%, χ2=4.245, P=0.039), a larger maximum attenuation arc〔(142±80)° vs. (115±54)°, t=5.254, P=0.000〕, larger plaque area〔(14.2±3.9)mm2vs. (12.3±4.1)mm2,t=2.325, P=0.022〕, more plaque burden 〔(81.1±14.2)% vs. (76.4±13.5)%, t=2.025, P=0.042〕 and higher remodeling index 〔(1.19±0.17) vs. (1.09±0.13), t=4.245, P=0.031〕. Conclusions The onset of ACS is more closely related with the unstable plaque in elderly patients, and strengthening the measures for plaque stabilization will be helpful in the prevention and treatment of ACS in the elderly. Key words: Acute coronary syndrome; Coronary angiography; Ultrasonography; Attenuated plaque

EFFECTIVENESS OF THE MINIMALLY INVASIVE MYOCARDIAL REVASCULARIZATION WITH AORTIC NO-TOUCH TECHNIQUE

Objectives. To estimate immediate and long term results of the minimally invasive coronary surgery (MICS) at the multiple lesions of the coronary arteries depending on completeness of the achieved myocardium revascularization for optimization of the surgical treatment of the patients with coronary heart disease (CHD). Materials and methods. From 2011 up to 2013 at the cardiac surgery department of ME “Vitebsk regional clinical hospital” 151 patients with the CHD underwent minimally invasive myocardium revascularization (MIMR) at the multiple lesions of coronary arteries. MIMR strategy was directed to avoid artificial cardiopulmonary bypass with cardioplegia and manipulations on the ascending aorta, usage of the left minithoracotomy access and tendency to perform complete or functionally reasonable arterial myocardium revascularization. 84 patients underwent complete MIMR, 67 patients - functionally reasonable incomplete MIMR. Results. Immediate results of the MIMR were found satisfactory (complete angina retrogression and absence of the major cardiovascular complications) in 99,3% patients and were compared in groups of patients who underwent complete (98,8%) or functionally reasonable (100%) MIMR (р>0,05). Operation time was longer and emergency conversion to the assist extracorporeal circulation (AECC) was more frequent in the complete MIMR group of patients in comparison with functionally reasonable MIMR group (р 0,05). There were no major differences in the frequency of the recrudescent angina and major cardiovascular complications (combined adverse patient outcome) between complete and functionally reasonable MIMR groups of patients during long-term follow-up - 2,41% and 5,97% respectively (р>0,05). Conclusion: MICS with aortic no-touch technique can be applied for majority of multivessel CHD patients as a complete, functionally reasonable or hybrid revascularization with or without AECC, saving the effectiveness and clinical effect duration of the coronary procedures.

Head‐to‐head comparison of sirolimus‐eluting stent versus bare metal stent evaluation of the coronary endothelial dysfunction in the same patient presenting with multiple coronary artery lesions: The CREDENTIAL study

To assess the endothelial dysfunction (ED) after bare metal stents (BMS) and sirolimus eluting stents (SES) implantation in the same patient, overcoming the confounding role of individual variables. SES reduce restenosis rate compared to BMS but causes more ED. ED is a potentially unsafe phenomenon, since it is the first step in the cascade of atherosclerosis. Studies showing more pronounced ED with drug eluting stents than BMS involved different series of patients, making the comparison difficult because endothelial function (EF) is responsive to many risk factors. we designed a prospective comparison of 6 months post-deployment EF of SES versus BMS implanted in the same patient, but in different coronary segments. Forty-eight lesions were randomly assigned on a 1:1 allocation using block sizing of 4 according to a computer-generated sequence (SAS System, Version 9.1) basis to treatment with SES or BMS. The EF was evaluated by measuring vessel diameter variation in the stented segment, before and after selective intracoronary infusion of acetylcholine (iiAch). In eligible patients, the relative magnitudes of major vasoconstriction were 2.6, 2.9, 4.6, and 3.1 at 5 mm proximal and 5, 10 and 20 mm distal to the stent edge. Overall, a 3.5-fold major distal vasoconstriction after iiAch of SES vs. BMS was calculated. in the same patients, but treating different coronary segments, SES implantation induces a higher rate of vasoconstriction compared to BMS. The increased vasoconstriction after iiAch is an indicator of ED.

CLINICAL EFFICACY OF GLYCOSAMINOGLYCANS IN PATIENTS WITH DIABETES MELLITUS AND ISCHEMIC HEART DISEASE

Aim. To study sulodexide clinical efficacy in patients with type 2 diabetes mellitus (DM) and ischemic heart disease (IHD) in prevention of contrast induced nephropathy (CIN). Material and мethods. Patients with type 2 DM and IHD who undergone X-Ray contrast intervention. The patients were randomized into 2 groups: 56 patients of the main group were i/v administered sulodexide (Vessel Due F , “Alfa Wassermann”, Italy) according to standard procedure; 56 patients of the control group were treated with unfractionated heparin. Results. The incidence of CIN in the main and control groups was, respectively , 16% and 42% (p&lt;0.01). Reduction of microalbuminuria (MAU) was found in 89.3% of the sulodexide group patients. MAU dynamics in patients of control group was not observed. There were no deteriorations in echocardiography characteristics in patients of both groups. The reduction in low density cholesterol and triglyceride plasma levels was observed in the main group. Sulodexide induced a lengthening of the activated partial thromboplastin time (from 30±0.6 to 34±0.5 s), without altering fibrinogen level. There were no thrombotic and hemorrhagic complications of endovascular intervention in sulodexide group. No one case of thrombocytopenia was observed. Higher risk of CIN in patients without sulodexide treatment compared with this in sulodexide treated patients was associated with multiple lesions of coronary arteries, diuretic intake in periprocedural period, contrast agent dose, duration of hospitalization, seriousness of intervention. Conclusion. Sulodexide therapy in patients with 2 type DM and IHD undergone X-Ray contrast intervention prevents renal dysfunction, providing antiproteinuric effect and correcting lipid metabolism and coagulation system disturbances.

CLINICAL EFFICACY OF GLYCOSAMINOGLYCANS IN PATIENTS WITH DIABETES MELLITUS AND ISCHEMIC HEART DISEASE

Aim. To study sulodexide clinical efficacy in patients with type 2 diabetes mellitus (DM) and ischemic heart disease (IHD) in prevention of contrast induced nephropathy (CIN). Material and мethods. Patients with type 2 DM and IHD who undergone X-Ray contrast intervention. The patients were randomized into 2 groups: 56 patients of the main group were i/v administered sulodexide (Vessel Due F , “Alfa Wassermann”, Italy) according to standard procedure; 56 patients of the control group were treated with unfractionated heparin. Results. The incidence of CIN in the main and control groups was, respectively , 16% and 42% (p<0.01). Reduction of microalbuminuria (MAU) was found in 89.3% of the sulodexide group patients. MAU dynamics in patients of control group was not observed. There were no deteriorations in echocardiography characteristics in patients of both groups. The reduction in low density cholesterol and triglyceride plasma levels was observed in the main group. Sulodexide induced a lengthening of the activated partial thromboplastin time (from 30±0.6 to 34±0.5 s), without altering fibrinogen level. There were no thrombotic and hemorrhagic complications of endovascular intervention in sulodexide group. No one case of thrombocytopenia was observed. Higher risk of CIN in patients without sulodexide treatment compared with this in sulodexide treated patients was associated with multiple lesions of coronary arteries, diuretic intake in periprocedural period, contrast agent dose, duration of hospitalization, seriousness of intervention. Conclusion. Sulodexide therapy in patients with 2 type DM and IHD undergone X-Ray contrast intervention prevents renal dysfunction, providing antiproteinuric effect and correcting lipid metabolism and coagulation system disturbances.

Head-to-Head Comparison of Sirolimus- and Paclitaxel-Eluting Stent in the Same Diabetic Patient With Multiple Coronary Artery Lesions

It is still controversial whether sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) are equally effective in patients with diabetes. In these patients, multiple individual variables may be responsible for neointimal hyperplasia, thus making difficult the comparison of the two drug-eluting stents (DES). We designed a prospective, randomized study to compare the efficacy in prevention of restenosis of SES and PES, both implanted in the same diabetic patient with multiple de novo coronary artery lesions undergoing elective percutaneous coronary intervention. We enrolled 60 patients with diabetes with at least two significant de novo angiographic stenoses in different coronary segments. The primary end point was in-stent late luminal loss (LLL) at 8-month angiographic follow-up. A total of 120 lesions were successfully treated with the randomly assigned DES (SES, n = 60; PES, n = 60). In-stent LLL was lower in the SES than in the PES group (0.26 +/- 0.4 vs. 0.50 +/- 0.6 mm; P = 0.01). Coronary lesions treated with SES presented a reduced in-stent LLL in 40 (68%) patients, while PES resulted in a lower in-stent LLL in 19 (32%) patients (P = 0.0002). At multivariable analysis, the type of DES implanted was the only independent predictor of in-stent LLL (odds ratio 2.3 [95% CI 1.1-5.0]; P = 0.03). SES directly compared with PES in the same diabetic patient is associated with a decrease in the extent of in-stent LLL at 8 months, suggesting a reduced risk of restenosis.

Simultaneous subacute stent thrombosis after implantation of sirolimus-eluting stent and bare-metal stent

Simultaneous multivessel stent thrombosis is a rare, but can cause catastrophic clinical results. We report a case occurred ST simultaneously in DES and BMS. Our case demonstrated that the use of multiple stents, irrespective of stent type, in multiple coronary artery lesions should be undertaken with great attention in the patient who has multiple adverse clinical predictors such as AMI.

重症多枝病変例（ＰＴＣＡ禁忌例）に対する冠血行再建術の検討

重症多枝病変例（ＰＴＣＡ禁忌例）に対する冠血行再建術の検討