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Dou KF, Xu B, Yang YJ, Chen JL, Qiao SB, Wang Y, Li JJ, Qin XW, Yao M, Liu HB, Wu YJ, Chen J, Yuan JQ, You SJ, Li W, Gao RL. Comparison of long-term clinical outcome after successful implantation of Firebird sirolimus- and Taxus paclitaxel-eluting stents in Chinese population: analysis of a large single center registry. Chin Med J (Engl) 2010; 123:810-815. [PMID: 20497669 DOI: 10.3760/cma.j.issn.0366-6999.2010.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Recent studies have shown that drug eluting stent (DES) implantation improved clinical outcome concerning efficacy compared with bare-metal stent (BMS) implantation, and sirolimus-eluting stent (SES) seemed superior to paclitaxel-eluting stent (PES) in improving the outcomes. Firebird SES is the most widely used SES in China. Long-term comparison of safety and efficacy between Firebird SES and Taxus PES in Chinese population is still not available. The aim of this research was to compare the safety and efficacy at 24 months after the successful implantation of Firebird SES and TAXUS PES in Chinese population. METHODS From April 2004 to October 2006, 3110 consecutive patients who underwent successful DES (Firebird SES 2274; Taxus PES 836) implantation were prospectively enrolled into this study. All enrolled patients were divided into two groups based on stent type. By outpatient clinic visit and telephone interview, we obtained 24-month clinical outcome including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of death, MI, and TVR). We used Cox's proportional-hazards models to assess relative risks of all the outcome measures before and after propensity match. RESULTS Unadjusted clinical outcomes indicated that the patients treated with Firebird SES were associated with lower risk of TLR (HR 0.38, 95%CI 0.26 - 0.54), TVR (HR 0.51, 95%CI 0.38 - 0.68) and MACE (HR 0.53, 95%CI 0.41 - 0.68). The results after propensity match were consistent with that before matching, lower risk of TLR (HR 0.33, 95%CI 0.19 - 0.58), TVR (HR 0.41, 95%CI 0.26 - 0.64), MACE (HR 0.48, 95%CI 0.33 - 0.68) in Firebird group. CONCLUSION Compared with Taxus PES, the use of domestic Firebird SES may decrease the risk of TLR, TVR and MACE in daily practice.
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Chen JL, Gao LJ, Yang YJ, Li JJ, Qiao SB, Xu B, Huang JH, Yao M, Qin XW, Liu HB, Wu YJ, Yuan JQ, Chen J, You SJ, Dai J, Gao RL. Comparison of the incidence of late stent thrombosis after implantation of different drug-eluting stents in the real world coronary heart disease patients: three-year follow-up results. Chin Med J (Engl) 2010; 123:778-781. [PMID: 20497663 DOI: 10.3760/cma.j.issn.0366-6999.2010.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Late stent thrombosis (LST) is still concerned by interventional cardiologists in daily clinical practice. This study aimed to compare the incidence of LST after implantation of different drug-eluting stents (DES) in coronary heart disease (CHD) patients in the real world. METHODS From December 2001 to February 2009, a total of 11 875 consecutive CHD patients undergone DES implantation were enrolled in this single-center registry study. Patients with acute ST-segment elevation myocardial infarction, mixed DES implantation, restenosis lesions, and patients who could not take dual antiplatelet medication and those who were contraindicated for coronary interventional treatment were excluded. All patients were treated with completed dual antiplatelet medications for at least 9 months after DES deployment. The follow-up was completed by outpatient visits, letter correspondence, phone calls and coronary angiography. Definite LST was diagnosed according to the Academic Research Consortium (ARC) definition. RESULTS Cypher or Cypher Select stents were implanted in 4104 cases, Taxus or Taxus Liberty stents in 2271 cases and Firebird stents (Chinese rapamycin-eluting stents) in 5500 cases. One-year follow-up was completed in 9693 patients, including 3346 cases with Cypher or Cypher Select stents, 1529 cases with Taxus or Taxus Liberty stents and 4818 cases with Firebird stents. Two- and three-year follow-up results were obtained in 7133 and 4353 patients, respectively, including 2410 and 1760 cases with Cypher or Cypher Select stents, 1285 and 900 cases with Taxus or Taxus Liberty stents as well as 3438 and 1693 cases with Firebird stents. One-year follow-up results showed that the incidence of LST was 1.08% in patients with Cypher or Cypher Select stents, 1.24% in those with Taxus or Taxus Liberty stents and 0.71% in those with Firebird stents; there was no significant difference between those with Cypher or Cypher Select and Firebird stents, but there was significant difference between those with Taxus or Taxus Liberty and Firebird stents (P = 0.044). The incidence of LST at the 2- and 3-year follow-up was 1.33% and 1.70% in those with Cypher or Cypher Select stents, 1.40% and 1.70% in those with Taxus or Taxus Liberty stents, and 0.83% and 0.95% in those with Firebird stents, respectively. There were no significant differences among the three groups. CONCLUSIONS This study indicates that first-generation DES are acceptable to treat complex coronary lesions, and there is no significant difference of LST for three different DES.
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Hu WL, Qiao SB, Li JJ. Corrigendum to “Decreased C-reactive protein-induced resistin production in human monocytes by simvastatin” [Cytokine 40 (2007) 201–206]. Cytokine 2009. [DOI: 10.1016/j.cyto.2009.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gao LJ, Chen JL, Chen J, Yang YJ, Gao RL, Li JJ, Qin XW, Qiao SB, Xu B, Yao M, Liu HB, Wu YJ, Yuan JQ, Chen J, You SJ, Dai J. Long-term clinical efficacy of cutting balloon angioplasty followed by bare metal stent implantation for treating ostial left anterior descending artery lesions. Clin Cardiol 2009; 32:E31-5. [PMID: 19479973 DOI: 10.1002/clc.20400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Drug-eluting stents (DES) are superior to bare metal stents (BMS) for treating ostial left anterior descending artery (LAD) lesions, but DES is not suitable for all patients in real life practice. HYPOTHESIS We hypothesize that cutting balloon angioplasty (CBA) followed by BMS (CBA + BMS) for treating ostial LAD lesions is an alternative strategy. METHODS In our study, 101 consecutive patients (51 with DES and 50 with CBA + BMS) with ostial LAD stenting were included for retrospective investigation between November 2003 and May 2005. The target vessel diameter was > or =3.0 mm. RESULTS We compared the DES group with the CBA + BMS group, the rates of restenosis (10.3% versus 17.9%, p = 0.386), target lesion revascularization (TLR) (5.88% versus 10%, p = 0.487) and major adverse cardiac events (MACE) (7.84% versus 12%, p = 0.525) were similar at 6-8 months angiographic follow-up, but there were higher bleeding events in the DES group (p = 0.033). During a 2-year clinical follow-up, no myocardial infarction occurred in the 2 groups, the rates of TLR (7.84% versus 10%, p = 0.741) and MACE (9.8% versus 12%, p = 0.723) were also similar. The MACE-free survival rate was 90.2% versus 88 % (p = 0.723). CONCLUSIONS The CBA + BMS combination has a good long-term clinical effect in the treatment of ostial LAD lesions; it might be an alternative strategy for patients with contraindication for DES implantation, or patients who cannot endure long-term dual antiplatelet medication, or in elderly patients.
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Liu SW, Qiao SB, Yuan JS, Liu DQ. Visfatin stimulates production of monocyte chemotactic protein-1 and interleukin-6 in human vein umbilical endothelial cells. Horm Metab Res 2009; 41:281-6. [PMID: 19009499 DOI: 10.1055/s-0028-1102914] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Monocyte chemotactic protein-1 and interleukin-6 are important inflammatory cytokines, which have close relationships with atherosclerosis. Visfatin is a novel adipokine involved in regulation of inflammatory cytokines, however, associations of visfatin with cytokines (MCP-1, IL-6) in human umbilical vein endothelial cells are unclear. The aim of this study was to determine whether visfatin has effects on the expression of MCP-1 and IL-6 in human umbilical vein endothelial cells. Enzyme-linked immunosorbent assay were used for measuring MCP-1 and IL-6 production in human umbilical vein endothelial cells. Real-time quantitative reverse-transcription polymerase chain reaction was used for determining MCP-1 and IL-6 mRNA expression. For the pathway determination following inhibitors were used: wortmannin [phosphatiylinositol 3-kinase (PI3K)], SB203580 [p38 mitogen-activated protein kinase (MAPK)], PD98059 [extracellular signal-regulated kinase (ERK) 1/2)], JNK inhibitor II [c-Jun NH 2-terminal kinase (JNK)]. We demonstrated that visfatin could obviously upregulate secretion of MCP-1and IL-6 in a dose- and time-dependent manner in human umbilical vein endothelial cells. Visfatin-induced effects were diminished by SB203580, wortmannin, and PD98059. In summary, these results suggest that visfatin-induced MCP-1 and IL-6 production involve p38 MAPK, PI3K, and ERK 1/2 pathways in human umbilical vein endothelial cells as determined by inhibition with specific inhibitors.
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Dou KF, Xu B, Yang YJ, Chen JL, Qiao SB, Li JJ, Qin XW, Liu HB, Wu YJ, Chen J, Yao M, You SJ, Yuan JQ, Dai J, Gao RL. Two-year clinical outcome after successful implantation of drug-eluting and bare metal stents in diabetic patients: results from a real-world single center registry. Chin Med J (Engl) 2009; 122:612-616. [PMID: 19323921 DOI: 10.3760/cma.j.issn.0366-6999.2009.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Drug-eluting stents (DES) have revolutionized the field of interventional cardiology by dramatically improving clinical and angiographic outcomes. Patients with diabetes mellitus (DM) are associated with an increased risk of adverse clinical outcomes after a percutaneous coronary intervention (PCI). Available information on the efficacy and safety of DES and bare metal stent (BMS) in diabetic patients remains scarce. METHODS From April 2004 to October 2006, 1565 patients with diabetes, who successfully underwent elective stenting at Fu Wai Hospital in Beijing, China, were enrolled in this study. All enrolled patients were assigned to a drug eluting stent group and a bare metal stent group. We obtained follow-up data: death, myocardial infarction (MI), thrombus, target lesion revascularization (TLR), and target vessel revascularization (TVR) at 30 days and 12 and 24 months, as defined by the Academic Research Consortium (ARC). We calculated and compared all the unadjusted cumulative frequencies of the various adverse events in the two groups. Cox's proportional-hazards models adjusted with the propensity score were used to assess the relative risks of all the outcome measures at 24 months. RESULTS At 24 months, all ARC defined stent thrombosis in the two groups were similar; at 30 days, a more definite thrombosis was found in the BES group (0.08% vs 0.81%, P = 0.016). Patients treated with DES showed a significant lower risk of TLR (3.88% vs 10.89%; hazard ratio (HR) 0.159 (95% CI: 0.151-0.444), P < 0.001), TVR (5.48% vs 11.69%; HR 0.383 (95% CI: 0.232-0.633), P < 0.001), and any revascularization (12.47% vs 18.55%; HR 0.555 (95% CI: 0.370-0.831), P = 0.0004) at 24 months. No significant difference was apparent in terms of all-cause mortality, MI, and all-cause mortality/MI. CONCLUSIONS In contemporary society's large, diabetic population, the use of DES is associated with long-term significant reductions in the risks of TLR, TVR, and any revascularization. There is no significant difference in all-cause mortality, MI, and thrombosis between DES and BMS in the patients with diabetes at 24-month follow-up.
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Liu HB, Xu B, Yang YJ, Wang Y, Qin XW, Yao M, Wu YJ, Yuan JQ, Chen J, You SJ, Dai J, Ma WH, Li JJ, Qiao SB, Chen JL, Li W, Gao RL. Long-term clinical outcomes after bioabsorbable polymer- and durable polymer-based sirolimus-eluting stents implantation: two-year follow-up results from a large single-center database. Chin Med J (Engl) 2009; 122:681-686. [PMID: 19323934 DOI: 10.3760/cma.j.issn.0366-6999.2009.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Several clinical trials have shown that sirolimus-eluting stents significantly reduce the risk of restenosis after percutaneous coronary intervention (PCI). The FIREBIRD stent (coated with durable polymer) and the EXCEL stent (coated with bioabsorbable polymer) are two different types of sirolimus-eluting stents made in China; both have been approved for clinical use in China by the State Food and Drug Administration. The mid-term (6-month) angiographic and clinical results of both stents have been confirmed exciting perspective outcomes. However, it is unclear whether there are differences in the long-term safety and efficacy between the two types of stents in daily practice. METHODS All consecutive patients undergoing elective PCI with EXCEL or FIREBIRD stents between June 1, 2006 and December 31, 2006 at Fu Wai Hospital in Beijing were included. Patients were classified from the index admission according to stent types (EXCEL or FIREBIRD) used. Clinical and procedural risk factors were collected prospectively. With propensity score matching without replacement, the frequency of major adverse cardiac events (MACE, a composite of death, myocardial infarction or target vessel revascularization) and stent thrombosis during a 2-year follow-up period were compared between the two groups. RESULTS A total of 474 patients were treated with EXCEL, and 640 were treated with FIREBIRD. Three hundred and ninety-seven EXCEL patients were matched to 397 FIREBIRD patients, 2-year risk-adjusted MACE rates were 6.1% in EXCEL group and 7.6% in FIREBIRD group (HR 0.84, 95% CI 0.50-1.43), whereas the respective rates for mortality, myocardial infarction and target-vessel revascularization were 2.3% vs 2.8% (HR 0.74, 95% CI 0.30-0.85), 1.8% vs 1.3% (HR 1.41, 95% CI 0.45-4.43) and 2.5% vs 4.0% (HR 0.62, 95% CI 0.28-0.37), respectively. Cumulative incidence of stent thrombosis at 2 years was 1.8% in the EXCEL group vs 1.3% in the FIREBIRD group (P = 0.5610), whereas the rate of very late stent thrombosis was 0.5% vs 1.3% (P = 0.2550). CONCLUSIONS Results from this long-term, relatively large size, single-center study showed that both of the EXCEL and the FIREBIRD sirolimus-eluting stent had similar and lower incidence of MACE after PCI in daily practice.
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Gao Z, Yang YJ, Xu B, Chen JL, Qiao SB, Li JJ, Qin XW, Yao M, Wu YJ, Yuan JQ, Chen J, Liu HB, Dai J, Gao RL. Long-term follow-up of crush versus no crush technique for coronary artery bifurcation lesions. Chin Med J (Engl) 2009; 122:627-631. [PMID: 19323924 DOI: 10.3760/cma.j.issn.0366-6999.2009.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Lesions at coronary bifurcations always are a big challenge for interventionists even with the advent of drug eluting stents (DES). Even as more clinical trials are published, operators still can not confirm that one strategy is more efficient than another. Selection of patients and short term follow-up contribute to the difficulty in comparing strategies. METHODS From April 2004 to April 2008, 505 consecutive Chinese patients underwent DES implantation for true bifurcation lesions; including 258 using crush strategy (213 male, (56.7 +/- 10.8) years old) and 247 using no crush strategy (206 male, (58.1 +/- 10.1) years old) were analyzed. RESULTS The follow-up period ranged from 237 to 1223 days, average (537 +/- 340) days for the crush group and (538 +/- 351) days for the no crush group. There was no significant difference of major adverse cardiac events (MACE) rate between the two groups (10.1% vs 12.1%; P = 0.481), nor in cardiac death, nonfatal myocardial infarction (MI) or in the target vessel revascularization (TVR) (0.4% vs 1.6%; P = 0.207, 2.7% vs 2.8; P = 1.000 and 7.0% vs 7.7%; P = 0.865). The stent thrombosis rate was similar in the two groups (1.6% vs 2.0%; P = 0.409), late and very late stent thrombosis in both groups were very low (0.4% vs 0.4%; P = 1.000). Seven-month angiographic follow-up showed no significant difference of the restenosis rate between the two groups (11.0% vs 13.5%; P = 0.786). During the follow-up, cardiac death, nonfatal MI, TVR and ST free survival rate showed no significant difference between the two groups. The only variant identified as a predictor of MACE was percutaneous coronary intervention (PCI) in the first two years, which accounted for 47% of patients of all cases in four years. CONCLUSION Crush technique showed similar long-term clinical effect compared with other two DES techniques for coronary bifurcation lesions, the surgeons' skills are very important for reducing clinical events.
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Luo XL, Qiao SB, Yuan JS, Guan T, Chen J, Chen JL, Song LF, Gao RL. [Clinical and echocardiographic characteristics of mitral chordal rupture from 292 hospitalized patients.]. ZHONGHUA XIN XUE GUAN BING ZA ZHI 2009; 37:253-256. [PMID: 19781152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To analyze the clinical, echocardiographic features and therapy efficacy of patients with ruptured mitral chordae tendineae. METHODS Clinical data, echocardiographic and pathological results from 292 hospitalized patients with ruptured mitral chordae tendineae were retrospectively analyzed. RESULTS There were 99 cases (33.9%) with rupture of anterior leaflet and 180 cases (61.6%) with rupture of posterior leaflet, 13 cases (4.5%) with both anterior and posterior leaflet ruptures. Partial rupture of mitral chordae tendineae was found in 266 cases (91.1%) and total rupture in 26 cases (8.9%). Two hundred and fourteen cases (73.3%) were primary chordal rupture and 78 (26.7%) were secondary chordal rupture (P < 0.05). Primary chordal rupture was mostly due to mucus degeneration of the mitral valve, mostly presented as posterior leaflet rupture in aged male patients. Secondary chordal rupture was mostly caused by infective endocarditis, coronary heart disease, congenital heart disease and rheumatic heart diseases. Patients with secondary chordal rupture cases were significantly younger than patients with primary chordal rupture and there were significantly more anterior leaflet rupture than posterior leaflet rupture. One hundred and thirty patients received mitral valve reconstruction operation and another 110 underwent mitral valve replacement therapy and discharged complication free. The remaining 52 cases received medication therapy and discharged with improved symptoms (12 with mild chordal rupture without operation indication, 17 cases contraindicated to operative therapy, 7 cases transferred to other hospitals and 16 patients refused operation therapy). CONCLUSIONS The incidence of posterior leaflet rupture is higher than that of anterior leaflet rupture. Rupture of both anterior and posterior leaflet is rare and there are more primary chordal ruptures than secondary chordal ruptures based on our patient cohort. Mitral valve reconstruction operation and mitral valve replacement therapy are effective operative therapy options for the treatment of mitral chordal ruptures in indicated patients.
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Gao Z, Yang YJ, Chen JL, Qiao SB, Xu B, Gao RL. [A comparative study of in-stent restenosis after drug eluting stents]. ZHONGHUA NEI KE ZA ZHI 2009; 48:122-125. [PMID: 19549466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare the long-term effect of three different drug-eluting stents (DES) for in-stent restenotic lesions. METHODS From April 2004 to June 2006, 390 consecutive patients undergoing DES implantation including 187 Cypher (group C), 89 Taxus (group T) and 114 Firebird (group F) with resulting in-stent restenotic lesions were studied. A mean of 2 year clinical and 7-month angiographic follow-up was carried out. RESULTS Baseline characteristics indicated that there were more unstable angina cases in T group and less left main disease and more triple vessel disease cases in F group. A mean of 2-year follow-up results showed no difference of major adverse cardiac events (MACE) rate among the three groups (23.0% vs 22.5% vs 13.2%, P = 0.081) and no difference of cardiac death, non-fatal myocardial infarction (MI) and target vessel revascularization rate (1.1% vs 4.5% vs 1.8%, P = 0.210, 5.9% vs 2.2% vs 2.6%, P = 0.226 and 2.9% vs 2.2% vs 0.9%, P = 0.509). There was no difference of total stent thrombosis or its components among the three groups (total: 4.8% vs 3.4% vs 2.6%, P = 0.605, early: 0.5% vs 0 vs 0.9%, P = 0.560, late: 1.6% vs 1.1% vs 0.9%, P = 0.849 and very late: 2.9% vs 2.2% vs 0.9%, P = 0.509) according to Academic Research Consortium (ARC) standard definitions (definite + probable). 7-month angiographic follow-up indicated that there was a lower trend of both in-stent and in-segment restenosis rate in C and F groups (17.9% vs 29.4% vs 13.6%, P = 0.214 and 21.8% vs 35.3% vs 15.9%, P = 0.132)and in-stent and in-segment late loss was significantly smaller in C and F groups [(0.31 +/- 0.12) mm vs (0.75 +/- 0.24) mm vs (0.31 +/- 0.13) mm, P = 0.000 and (0.33 +/- 0.18) mm vs (0.61 +/- 0.23) mm vs (0.31 +/- 0.14) mm, P = 0.001]. RESULTS from this 2-year follow-up, single-center study showed comparable effectiveness and safety of Cypher, Taxus and Firebird DES for in-stent restenotic lesions, but Cypher and Firebird had better effect in reducing restenosis.
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Zhang Q, Xu B, Yang YJ, Qiao SB, Zhang RY, Zhang JS, Hu J, Qin XW, Chen JL, Shen WF, Gao RL. Long-term efficacy and safety of Chinese made sirolimus eluting stents: results, including off label usage, from two centres over three years. Chin Med J (Engl) 2008; 121:1670-1674. [PMID: 19024097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Multiple randomized clinical trials have demonstrated that drug eluting stents can significantly reduce the rates of restenosis and subsequent adverse events across lesion and patient. We investigated the medium term clinical efficacy and safety of Firebird sirolimus eluting stent (SES) in coronary artery disease. METHODS The sample was 509 consecutive patients with coronary artery disease (CAD) who were treated by Firebird SES and finished three-year clinical follow-up. The occurrences of major adverse cardiac events (MACE) and Academic Research Consortium defined stent thrombosis (ST) were evaluated in patients with and without diabetes mellitus. RESULTS Three hundred and thirty three patients (65.4%) were treated by Firebird SES by off label indications. Angiographic success was achieved in 98.3% of the lesions. MACE and target vessel revascularization rates at 6-month, 1 year's and 3 years' clinical follow-up were 2.4% and 1.4%, 4.1% and 2.8%, 7.9% and 5.1%, respectively. The cumulative 3-year MACE free survival rate was 92.1%. After 3 years, DM patients had significantly higher rates of MACE (13.7% vs 6.4%, P < 0.05) and TVR (9.8% vs 4.0%, P < 0.05) and the cumulative MACE free survival rate was very significantly lower in the DM group (86.4% vs 93.6%, P < 0.05). ST occurred in 7 patients (1.4%) at the end of 3 years' follow-up, 5 of them had definite ST with 4 cases presenting with myocardial reinfarction and 1 with unstable angina, the other 2 with probable ST had reinfarction in the stented coronary territory without angiographic follow-up. There was no difference in occurrence of ST between off label (1.5%) and on label groups (1.1%, P = 0.07). CONCLUSIONS In daily practice, about 2/3 of patients were treated by Firebird SES by off label indications. Medium term clinical follow-up of 3 years indicated CAD patients treated by Firebird SES had a low MACE and acceptable ST rate. DM patients had higher rates of adverse events and than non DM.
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Gao LJ, Chen JL, Chen J, Gao RL, Yang YJ, Xu B, Qin XW, Qiao SB, Yao M, Liu HB, Wu YJ, Yuan JQ, Chen J. [Comparison of different drug-eluting stents in the treatment of coronary artery disease: a single center four-year clinical follow-up]. ZHONGHUA NEI KE ZA ZHI 2008; 47:541-544. [PMID: 19035161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To investigate the outcomes of sirolimus-eluting stent (Cypher, Cordis/Johnson & Johnson, Warren, NJ, USA) and paclitaxel-eluting stent (Taxus, Boston Scientific, Natick, MA, USA) in the treatment of coronary heart disease after a four-year clinical follow-up. METHODS 237 consecutive patients were enrolled in this study and treated with Cypher (136 patients) or Taxus (101 patients) from January to October 2003. The rates of stenosis, stent thrombosis according to ARC definition and major adverse cardiac events (MACE a composite of cardiac death, myocardial infarction and target vessel revascularization) were analysed. RESULTS There was no significant difference on secondary restenosis, target lesion revascularization (TLR) and MACE between Cypher and Taxus groups at six-month angiographic follow-up, but late luminal loss was higher in Taxus group [(0.15 +/- 0.43) mm vs (0.42 +/- 0.34) mm, P = 0.022]. At four-year follow-up, TVR-free survival rate was 88.97% in Cypher group versus 82.28% in Taxus group (P = 0.158). MACE-free survival rate was 83.8% in Cypher group and 79.2% in Taxus group (P = 0.056). The incidence of stent thrombosis was no difference between the two groups (1.47% vs 1.98%). There was also no difference among early (0 vs 0.99%), late (0.73% vs 0.99%) and very late stent thrombosis (0.73% vs 0) between the 2 groups. CONCLUSIONS There were no difference between Cypher and Taxus in the treatment of coronary artery disease; Both Cypher and Taxus have good clinical outcomes except that Taxus had higher late loss.
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Li CJ, Gao RL, Yang YJ, Hu FH, Yang WX, You SJ, Song LF, Ruan YM, Qiao SB, Chen JL, Chen ZJ. [Effect of intracoronary transplantation of autologous bone marrow mononuclear cells on myocardial ischemia reperfusion injury in mini-swine model]. ZHONGGUO YI XUE KE XUE YUAN XUE BAO. ACTA ACADEMIAE MEDICINAE SINICAE 2008; 30:86-90. [PMID: 18361060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the therapeutic effectiveness of intracoronary transplantation of autologous bone marrow mononuclear cells (BM-MNC) on myocardial ischemia reperfusion injury in mini-swine model. METHODS Myocardial ischemia reperfusion injury model was established by ligating in 16 mini-swines, which were further randomized into two groups: (3.54 +/- 0.90) x 10(8) BM-MNC was intracoronarily transplanted in BM-MNC group (n = 9), and phosphate buffer saline was intracoronarily applied in the control group (n = 7). Ultrasonic cardiograhpy, hemodynamics, neovascular density, and myocardium infarction size were evaluated before and 4 weeks after transplantation. RESULTS In BM-MNC group, left ventricular ejection fraction (LVEF), intra-ventricular septa, lateral wall and anterior wall, cardiac output (CO) and + dp/dt(max) had no significant differences before and 4 weeks after transplantation (P > 0.05). In the control group, LVEF, intraventricular septa, lateral wall and anterior wall, CO, and + dp/dt(max) significantly decreased 4 weeks after transplantation (P < 0.05). Left ventricular end-diastolic pressure and- dp/dt(max) had no significant differences before and after cell transplantation. Capillary density was significantly larger in the BM-MNC group than in the control group [(13.39 +/- 6.96) /HP vs. (3.50 +/- 1.90) /HP]. The percentage and size of myocardial infarction was significantly lower in the BM-MNC group than in the control group. CONCLUSION Transplantation of BM-MNC into the myocardial ischemic reperfusion-injury area can increase capillary density and decrease infarction area, and thus remarkably improve cardiac systolic function.
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Li CJ, Gao RL, Yang YJ, Song LF, Ruan YM, Hu FH, Yang WX, Chen JL, Qiao SB, Qin XW, Liu YQ, Chen ZJ. [Autologous bone marrow mononuclear cells and peripheral endothelial progenitor cells differentiation in myocardial ischemia reperfusion injury region in swine]. ZHONGHUA XIN XUE GUAN BING ZA ZHI 2007; 35:350-3. [PMID: 17711663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To investigate the differentiation status of autologous bone marrow mononuclear cells (BM-MNC) and peripheral endothelial progenitor cells (EPC) transplanted into myocardial ischemia reperfusion injury region in swine. METHODS BM-MNC marked with PKH26 (n = 9), EPC marked with CM-DiI (n = 7), phosphate buffer saline (control, n = 7) were transplanted into myocardial ischemia reperfusion injury region of swine by intracoronary artery injection. Specimens were harvested 4 weeks after injection for histological analysis (HE, immunochemical stain for vWF, alpha-sarcomeric-actin and fibronectin antibody). Cell differentiation was observed under transmission electronmicroscope. RESULTS The number of small blood vessels was similar between BM-MNC group and EPC group (13.39 +/- 6.96/HP vs.12.39 +/- 4.72/HP, P < 0.05), but was significantly higher than that of control group (P < 0.05). Responsive intensity of immunochemical stain for fibronectin antibody was significantly lower in BM-MNC and EPC groups than that in control group. Responsive intensity of immunochemical stain for alpha-sarcomeric-actin antibody was similar among the three groups. Cluster cells were observed in one swine from BM-MNC group which might relate to the proliferation of stem cells in situ. Immature endothelial cells and myocytes were also detected by transmission electronmicroscope in BM-MNC and EPC group. CONCLUSION BM-MNC and EPC transplanted into myocardial ischemia reperfusion injury region in swine stimulated the formation of blood vessels and inhibited fibrogenesis.
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Chen JL, Yang YJ, Qiao SB, Yao M, Qin XW, Xu B, Liu HB, Wu YJ, Yuan JQ, Chen J, You SJ, Dai J, Li JJ, Gao RL. [Procedural success and 10-month outcome between Cypher and TAXUS drug-eluting stents for the treatment of in-stent restenosis]. ZHONGHUA XIN XUE GUAN BING ZA ZHI 2007; 35:305-7. [PMID: 17711652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To compare the procedural success and 10-month outcome between sirolimus-eluting stent (Cypher stent) and paclitaxel-eluting stent (TAXUS stent) for the treatment of in-stent restenosis lesions. METHODS Patients with in-stent restenosis treated with drug-eluting stents (DES) from December 2002 to March 2005 were included in this study and 10 months post stenting follow-up data were reported. RESULTS A total of 253 patients with 262 in-stent restenosis lesions were treated with 176 Cypher and 132 TAXUS stents. There were 29 total occlusion, 143 > or = 90% stenosis and 90 < 90% stenosis lesions. Target lesion type distributions were as follows: 9 type A, 45 type B1, 73 type B2 and 135 type C lesions. The mean diameter in Cypher group (2.96 +/- 0.27) mm was smaller than that of TAXUS (3.05 +/- 0.35 mm, P = 0.041) and mean DES length was similar between the two groups (23.31 +/- 6.68 mm vs. 23.56 +/- 6.54 mm, P = 0.745). Procedural success rate of DES implantation was 100% for both Cypher and TAXUS groups. MACE rate during hospitalization was similar between the two groups. At 10-month follow up, MACE rate was significantly higher in TAXUS group than that in Cypher group (16.0% vs. 6.7% P = 0.031) and angiographic in-stent restenosis rate tended also higher in TAXUS group than that in Cypher group (29.4% vs. 14.0%, P = 0.075). CONCLUSION Procedural success rate was similar between Cypher and TAXUS groups and the angiographic and clinical outcome at 10 months was better in Cypher DES group than in TAXUS DES group.
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Chen JL, Yang YJ, Qiao SB, Yao M, Qin XW, Xu B, Liu HB, Wu YJ, Yuan JQ, Chen J, You SJ, Dai J, Li JJ, Gao RL. Comparison of short- and long-term outcomes between Cypher and TAXUS drug-eluting stents for in-stent restenosis. CHINESE MEDICAL SCIENCES JOURNAL = CHUNG-KUO I HSUEH K'O HSUEH TSA CHIH 2007; 22:5-8. [PMID: 17441309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To compare the short- and long-term clinical outcomes between sirolimus-eluting stent (Cypher stent) and paclitaxel-eluting stent (TAXUS stent) in patients with in-stent restenosis (ISR) lesions of the coronary arteries. METHODS From December 2002 to March 2005, 253 patients with ISR lesions of the coronary arteries were selected and divided into two groups. Cypher group (152 cases) was treated with Cypher or Cypher Select stents, and TAXUS group (101 cases) with TAXUS stents. A total of 262 ISR lesions in these patients were treated with 308 drug-eluting stents (DESs), including 176 Cypher or Cypher Select stents and 132 TAXUS stents. All patients were followed up for 10 months. Procedure success rates of DES implantation in both groups were observed. Major adverse cardiac events (MACE) rates in hospital and at 10 months follow-up, as well as in-DES restenosis observed using coronary angiography at follow-up were compared between two groups. RESULTS Success rate of DES implantation was 100% in both groups. No significant difference in MACE rate during hospitalization was found between the two groups. However, at 10 months follow-up, MACE rate was higher in TAXUS group than in Cypher group (16.00% vs. 6.67% , P = 0.031). As for coronary angiography at 10 months follow-up, we observed an increasing tendency of in-DES restenosis rate in TAXUS group compared with Cypher group (29.41% vs. 14.04%, P = 0.075). CONCLUSIONS Cypher and TAXUS DESs both have good short- and long-term outcomes in treating ISR. Cypher DES proved better long-term clinical outcome than TAXUS DES.
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Chen JL, Gao RL, Yang YJ, Qiao SB, Qin XW, Yao M, Xu B, Liu HB, Wu YJ, Yuan JQ, Chen J, You SJ, Dai J. [Short-term and long-term outcomes of treating bifurcation lesions with two drug eluting stent techniques]. ZHONGHUA XIN XUE GUAN BING ZA ZHI 2006; 34:1089-92. [PMID: 17274897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To evaluate the clinical outcomes of treating bifurcation lesions with two drug-eluting stent (DES) techniques. METHODS From October 2003 to June 2005, 112 patients with 113 bifurcation lesions with severe stenosis at the ostium of side branch and the diameter > or = 2.50 mm were treated by two DES. Sixty-two of the bifurcation lesions were located in LAD/diagonal (54.9%), 32 in distal left main coronary arteries (28.3%), 18 in LCX/OM (15.9%) and 1 distal RCA (0.9%). Sixty-four lesions were treated with Crush technique, 27 with "T-form" stent implanting technique, 11 with modified "Y-form" stent implanting technique, 5 with kissing technique, 3 with "V-form" stent implanting technique and 3 with Culotta technique. Ninety-one Cypher or Cypher select DES stents, 74 TAXUS DES stents, 67 Firebird stents were used for 226 lesions. Final kissing balloon inflation was performed in 60 bifurcation lesions (93.7%) after 64 Crush stenting procedure. RESULTS Success rate of PCI procedure for the bifurcation lesions was 100%. One patient developed subacute stent thrombosis and underwent successful urgent revascularization. In-hospital major adverse cardiac events (death, AMI, revascularization, MACE) rate was 0.89% (1/112). Nine months follow-up was made in all 112 patients and all patients were alive and MACE rate was 8.04% (9/112) with 1 AMI occurred during the follow-up period in 1 patient due to late thrombosis. Follow-up coronary angiography at 9 months was performed in 48 patients (42.9%) and evidenced 8 in-stent restenosis (16.7%) and 1 patient received CABG, re-PCI was performed in 5 patients. CONCLUSION Two DES technique for the treatment of bifurcation lesions is safe and effective and short- and long-term outcomes is satisfactory.
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Luo T, Yang YJ, Song R, Gao RL, Chen JL, Qiao SB, Qin XW, Yao M, Liu HB, Wu YJ, Chen ZJ. [Coronary angiographic findings within 6 months after first myocardial infarction: a report of 878 cases]. ZHONGHUA YI XUE ZA ZHI 2004; 84:910-4. [PMID: 15329276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To investigate the characteristics of coronary lesions in patients after first myocardial infarction (MI). METHODS From May 1998 to December 2000, coronary angiography was performed on 878 consecutive cases who had had first MI within 6 months and without history of previous coronary revascularization, 481 with anterior-lateral MI, 368 with inferior-posterior MI, 19 with posterio-lateral MI, and 10 with location-undetermined MI, and 394 receiving thrombolytic therapy 176 (44.7%) of which were treated successfully, and 525 (59.8%) with history of pre-infarction angina pectoris and 428 (48.7%) with history of post-infarction angina pectoris. RESULTS (1) Normal coronary vessels or lesions less than 50% stenosis were seen only in 5.9% (52) of the patients. One-, two- and three-vessel diseases were present in 32.8% (288), 26.4% (232) and 34.9% (306) patients respectively. 3.2% (28) had concomitant left main stem (LMS) disease. Three-vessel coronary disease was significantly more common in the patients with a history of pre-infarction angina in comparison with those without such history (39.2% vs 28.3%, P < 0.01), and was significantly more common in the patients who did not undergo thrombolytic therapy in comparison with those who had received thrombolytic therapy (38.4% vs 30.5%, P < 0.05). (2) Only in 5.1% (41) cases the infarct-related artery (IRA) was normal or with lesions less than 50% stenosis. Total occlusion (100% stenosis), subtotal occlusion (95% to 99% stenosis), severe stenosis (70% to 94% stenosis) and borderline stenosis (50% to 69% stenosis) of IRA were seen in 29.6% (240), 22.6% (183), 37.9% (307) and 4.9% (40) of the cases respectively. Total occlusion of IRA occurred significantly less often in the thrombolytic group than in the non-thrombolytic group (24.6% vs 33.7%, P < 0.01). IRA could not be determined in 67 cases. (3) 90.5% (795), 79.4% (697), 57.2% (502) and 35.6% (313) of the patients had > or = 70% stenosis, > or = 90% stenosis, > or = 95% stenosis and total occlusion coronary lesions in at least one major coronary artery respectively, and coronary revascularization including PCI and CABG was needed on 84% (736/878) of the patients. CONCLUSION Patients with a first MI usually have multi-vessel disease and severe coronary stenosis, with IRA having severe stenotic lesions. Revascularization treatment is needed in the majority of the patients. It is true too for the MI patients without history of pre- or post-infarction angina pectoris and those with successful thrombolytic therapy. Coronary angiography should routinely be performed on the patients who need further coronary revascularization.
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