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Chieffo A, Magni V, Colombo A. Percutaneous Coronary Intervention in Unprotected Left Main. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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102
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Rekik S, Brunet J, Bayet G, Hager FX, Meille L, Quatre JM, Sainsous J. EuroSCORE is a good global predictor of long-term outcomes in high-risk but not in low-risk patients after unprotected left main angioplasty. Catheter Cardiovasc Interv 2011; 77:625-32. [DOI: 10.1002/ccd.22669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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103
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Lee JY, Park DW, Kim YH, Yun SC, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ. Incidence, Predictors, Treatment, and Long-Term Prognosis of Patients With Restenosis After Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease. J Am Coll Cardiol 2011; 57:1349-58. [PMID: 21414531 DOI: 10.1016/j.jacc.2010.10.041] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 10/04/2010] [Accepted: 10/04/2010] [Indexed: 11/24/2022]
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104
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Wu X, Chen Y, Kubo T, Ge C, Ren F, Wu X, Chen W, Zhou Hong Liu Y, Lv S. Long-term (4-year) outcomes and predictors of adverse cardiac events after sirolimus-eluting stent implantation in unprotected left main coronary artery. Int Heart J 2011; 51:377-82. [PMID: 21173511 DOI: 10.1536/ihj.51.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The long-term safety and efficiency of sirolimus-eluting stent (SES) treatment in unprotected left main coronary artery (ULMCA) have not yet been ascertained.From 2003 to 2006, 126 consecutive patients with de novo lesions in ULMCA who underwent SES were retrospectively analyzed in a single center in China. During 4-year follow-up, major adverse cardiovascular event (MACE)-free survival was 74.6%. Cardiac death occurred in 5 (4.0%), and target lesion revascularization (TLR) and target vessel revascularization (TVR) occurred in 15 (11.9%) and 24 (19.0%) patients, respectively. One (0.8%) experienced probable stent thrombosis while 1 (0.8%) presented possible stent thrombosis. Impaired LVEF (< 40%) and high surgical risk (Euro score > 6) were the independent predictors of MACEs.PCI with SES for de novo lesions in ULMCA is feasible with a low procedural risk. However, SES was associated with a relatively higher rate of TLR and TVR. Impaired LVEF and high surgical risk were important predictors of MACEs.
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Affiliation(s)
- Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Wakayama, Japan
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105
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Dorfman TA, Aqel R. Palliative combined percutaneous balloon aortic valvuloplasty and unprotected left main stenting in end stage renal disease. Curr Cardiol Rev 2011; 6:41-5. [PMID: 21286277 PMCID: PMC2845793 DOI: 10.2174/157340310790231590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 03/22/2009] [Accepted: 03/31/2009] [Indexed: 12/03/2022] Open
Abstract
With the aging population and high prevalence of atherosclerosis, an increasing number of patients presenting with heart failure and angina are found to have severe coronary artery disease and severe valvular disease. These patients tend to have multiple co-morbidities such as end stage renal disease and are considered high-risk for surgery. In patients with severe coronary artery disease, severe aortic stenosis, and heart failure with depressed left ventricular systolic function, the options are limited as they are not usually offered surgery, but palliative percutaneous high-risk procedures might be a viable alternative. Though long term results after balloon aortic valvuolpasty are not promising, there is a role for these procedures in high-risk inoperable patients for either palliation or as a bridge to surgery. Unprotected left main percutaneous interventions are also feasible with low complication rates. This review provides mounting evidence that it is reasonable to perform combined palliative balloon aortic valvuolpasty and high-risk coronary artery stenting in certain inoperable patients. An illustrative case is presented that extends the findings of the current literature and demonstrates that combined balloon aortic valvuolpasty and left main stenting could be a safe and effective alternative in the setting of heart failure, left ventricular dysfunction, and end stage renal disease.
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Affiliation(s)
- Todd A Dorfman
- Division of Cardiovascular Disease at the University of Alabama at Birmingham, and the Division of Cardiovascular Disease, Birmingham Veterans Affair Medical Center, Birmingham, Alabama
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106
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Lee JWY, Lee BS, Lee JY, Ku HJ, Jeon SR, Kim JY, Ban JM, Sung SH, Shin HM, Park JE. The herbal extract HMC05 inhibits neointima formation in balloon-injured rat carotid arteries: possible therapeutic implications of HMC05. JOURNAL OF ETHNOPHARMACOLOGY 2011; 133:168-176. [PMID: 20883768 DOI: 10.1016/j.jep.2010.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/27/2010] [Accepted: 09/17/2010] [Indexed: 05/29/2023]
Abstract
AIM OF THE STUDY In a previous study, HMC05, a water extract from eight medicinal herbs was demonstrated to possess anti-inflammatory effects in murine macrophages and anti-atherosclerotic effects in apoE(-/-) mice. HSP27 expression was shown to be decreased in advanced atherosclerotic plaques of human carotid arteries. In the present study, the role of HMC05 in the prevention of restenosis and the possible mechanisms involved in the decrease of neointima formation were investigated using in vivo balloon injury rat model and in vitro biochemical assays. MATERIALS AND METHODS A rat carotid artery balloon injury restenosis model was used. Different doses of HMC05 were administered to the rats by tube feeding, starting from four days before surgery and continuing twice per week for two weeks after carotid injury. Injured carotid arteries isolated from rats were embedded in paraffin block and tissue sections were stained with H&E to assess neointima formation. Mechanism by HMC05 that are involved in smooth muscle cell proliferation and migration was assessed by western blot assay, immunohistochemistry and confocal analysis. RESULTS There was no significant difference in the medial area between the control and HMC05-treated groups. However, neointima formation was significantly inhibited in the HMC05-treated group, resulting in 47-fold lower intima to media ratios in rats treated with 25 mg/kg/day HMC05 as compared to the control. Surprisingly, monocytes infiltration in the neointima area was almost completely blocked by HMC05 administration. When rat vascular SMCs were treated with HMC05, the proliferation and migration of smooth muscle cells was dramatically inhibited in a dye uptake assay and in a scratch model in a culture dish, respectively. HMC05 dose-dependently inhibited PDGF-mediated MAPK and AKT activation. However, HMC05 did not affect PDGF-mediated HSP27 phosphorylation but it induced HSP27 overexpression and phosphorylation. In addition, medial SMCs in the arterial wall of rats treated with HMC05 showed a significant increase in HSP27 expression compared with that of the control rats. CONCLUSIONS HMC05, a strong anti-inflammatory reagent, might use HSP27 as an effector molecule in SMCs to reduce neointimal hyperplasia by inhibiting PDGF-mediated MAPK and AKT activation. HMC05 could be a useful drug candidate for the prevention of restenosis after balloon injury of the arteries.
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MESH Headings
- Animals
- Anti-Inflammatory Agents/pharmacology
- Becaplermin
- Carotid Arteries/drug effects
- Carotid Arteries/metabolism
- Carotid Artery Injuries/pathology
- Catheterization
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Cells, Cultured
- Coronary Restenosis/prevention & control
- Disease Models, Animal
- HSP27 Heat-Shock Proteins/metabolism
- Humans
- Male
- Mice
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Neointima/prevention & control
- Phytotherapy
- Plant Extracts/pharmacology
- Plants, Medicinal
- Plaque, Atherosclerotic/pathology
- Plaque, Atherosclerotic/prevention & control
- Platelet-Derived Growth Factor/metabolism
- Proto-Oncogene Proteins c-sis
- Rats
- Signal Transduction
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Affiliation(s)
- Jo Woon Yi Lee
- Division of Cardiology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
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107
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Kadota K, Mitsudo K. Percutaneous Coronary Intervention With Drug-Eluting Stent for Unprotected Left Main Trunk Disease: Safety and Efficacy Compared With Bare Metal Stent. Circ J 2011; 75:1250-4. [DOI: 10.1253/circj.cj-11-0307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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108
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Affiliation(s)
- Seung-Jung Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center
| | - Duk-Woo Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center
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109
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Pandya SB, Kim YH, Meyers SN, Davidson CJ, Flaherty JD, Park DW, Mediratta A, Pieper K, Reyes E, Bonow RO, Park SJ, Beohar N. Drug-eluting versus bare-metal stents in unprotected left main coronary artery stenosis a meta-analysis. JACC Cardiovasc Interv 2010; 3:602-11. [PMID: 20630453 DOI: 10.1016/j.jcin.2010.03.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/18/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We undertook a meta-analysis to assess outcomes for drug-eluting stents (DES) and bare-metal stents (BMS) in percutaneous coronary intervention for unprotected left main coronary artery (ULMCA) stenosis. BACKGROUND Uncertainty exists regarding the relative performance of DES versus BMS in percutaneous coronary intervention for unprotected left main coronary stenosis. METHODS Of a total of 838 studies, 44 met inclusion criteria (n = 10,342). The co-primary end points were mortality, myocardial infarction (MI), target vessel/lesion revascularization (TVR/TLR), and major adverse cardiac events (MACE: mortality, MI, TVR/TLR). RESULTS Event rates for DES and BMS were calculated at 6 to 12 months, at 2 years, and at 3 years. Crude event rates at 3 years were mortality (8.8% and 12.7%), MI (4.0% and 3.4%), TVR/TLR (8.0% and 16.4%), and MACE (21.4% and 31.6%). Nine studies were included in a comparative analysis (n = 5,081). At 6 to 12 months the adjusted odds ratio (OR) for DES versus BMS were: mortality 0.94 (95% confidence interval [CI]: 0.06 to 15.48; p = 0.97), MI 0.64 (95% CI: 0.19 to 2.17; p = 0.47), TVR/TLR 0.10 (95% CI: 0.01 to 0.84; p = 0.01), and MACE 0.34 (95% CI: 0.15 to 0.78; p = 0.01). At 2 years, the OR for DES versus BMS were: mortality 0.42 (95% CI: 0.28 to 0.62; p < 0.01), MI 0.16 (95% CI: 0.01 to 3.53; p = 0.13), and MACE 0.31 (95% CI: 0.15 to 0.66; p < 0.01). At 3 years, the OR for DES versus BMS were: mortality 0.70 (95% CI: 0.53 to 0.92; p = 0.01), MI 0.49 (95% CI: 0.26 to 0.92; p = 0.03), TVR/TLR 0.46 (95% CI: 0.30 to 0.69; p < 0.01), and MACE 0.78 (95% CI: 0.57 to 1.07; p = 0.12). CONCLUSIONS Our meta-analysis suggests that DES is associated with favorable outcomes for mortality, MI, TVR/TLR, and MACE as compared to BMS in percutaneous coronary intervention for unprotected left main coronary artery stenosis.
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Affiliation(s)
- Sanjay B Pandya
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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111
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Garg S, Serruys PW. Coronary Stents. J Am Coll Cardiol 2010; 56:S1-42. [PMID: 20797502 DOI: 10.1016/j.jacc.2010.06.007] [Citation(s) in RCA: 307] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 01/07/2023]
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112
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Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR, Torracca L, van Es GA, Leadley K, Dawkins KD, Mohr F. Outcomes in Patients With De Novo Left Main Disease Treated With Either Percutaneous Coronary Intervention Using Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment in the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) Trial. Circulation 2010; 121:2645-53. [PMID: 20530001 DOI: 10.1161/circulationaha.109.899211] [Citation(s) in RCA: 425] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marie-Claude Morice
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Patrick W. Serruys
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - A. Pieter Kappetein
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Ted E. Feldman
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Elisabeth Ståhle
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Antonio Colombo
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Michael J. Mack
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - David R. Holmes
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Lucia Torracca
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Gerrit-Anne van Es
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Katrin Leadley
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Keith D. Dawkins
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Friedrich Mohr
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
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113
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Wu X, Chen Y, Liu H, Teirstein PS, Kirtane AJ, Ge C, Song X, Chen X, Gu C, Huang F, Lv S. Comparison of long-term (4-year) outcomes of patients with unprotected left main coronary artery narrowing treated with drug-eluting stents versus coronary-artery bypass grafting. Am J Cardiol 2010; 105:1728-34. [PMID: 20538122 DOI: 10.1016/j.amjcard.2010.01.353] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 01/27/2010] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
Abstract
Percutaneous coronary intervention with drug-eluting stents (DES) may achieve midterm outcomes comparable to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease, but few real-world, long-term studies have been reported. In this study, 376 patients with unprotected left main coronary artery disease who underwent DES implantation (n = 131) or CABG (n = 245) were evaluated, and outcomes were compared using propensity analyses to adjust for baseline differences. Overall, 367 patients (98%) had complete clinical follow-up for a median of 4.0 years (interquartile range 3.2 to 4.7). Although the overall sample size was limited, there was a trend toward lower mortality with DES versus CABG in unadjusted (hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.20 to 1.22, p = 0.13), multivariate-adjusted (HR 0.37, 95% CI 0.13 to 1.09, p = 0.07), and propensity score-adjusted (HR 0.34, 95% CI 0.12 to 1.03, p = 0.06) analyses. Treatment with DES was associated with a higher rate of target-vessel revascularization (TVR; 18% vs 9%, p = 0.02). However, ischemic TVR was not significantly different between the 2 groups (25% vs 39%, p = 0.15) in patients who received angiographic follow-up. No differences were detected in the occurrence of composite major adverse cardiac and cerebrovascular events between DES and CABG (27% vs 22%, p = 0.42). In conclusion, during 4-year follow-up, overall composite major adverse cardiac and cerebrovascular events were similar after DES and CABG treatment of unprotected left main coronary artery disease, with a trend toward lower mortality after percutaneous coronary intervention with DES. DES were associated with a higher rate of TVR compared to CABG, but ischemic TVR was not significantly different between the 2 groups.
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114
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Gertz ZM, Wilensky RL. Local Drug Delivery for Treatment of Coronary and Peripheral Artery Disease. Cardiovasc Ther 2010; 29:e54-66. [DOI: 10.1111/j.1755-5922.2010.00187.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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115
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Impact of the Extent of Coronary Artery Disease on Outcomes After Revascularization for Unprotected Left Main Coronary Artery Stenosis. J Am Coll Cardiol 2010; 55:2544-52. [DOI: 10.1016/j.jacc.2009.11.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 11/25/2009] [Accepted: 11/30/2009] [Indexed: 11/21/2022]
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116
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Onuma Y, Girasis C, Piazza N, Garcia-Garcia HM, Kukreja N, Garg S, Eindhoven J, Cheng JM, Valgimigli M, van Domburg R, Serruys PW. Long-Term Clinical Results Following Stenting of the Left Main Stem. JACC Cardiovasc Interv 2010; 3:584-94. [DOI: 10.1016/j.jcin.2010.03.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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117
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Goyal BK. Percutaneous UPLM revascularisation: the time has come. Catheter Cardiovasc Interv 2010; 75:1050. [PMID: 20517967 DOI: 10.1002/ccd.22631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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118
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New top coating system of chemically anchored phospholipid monolayer on the drug-encapsulated polymer film for drug-eluting stent. Macromol Res 2010. [DOI: 10.1007/s13233-010-0515-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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119
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120
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Park SJ, Kim YH. Percutaneous coronary intervention for unprotected left main coronary artery stenosis. World J Cardiol 2010; 2:78-88. [PMID: 21160702 PMCID: PMC2998877 DOI: 10.4330/wjc.v2.i4.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 04/05/2010] [Accepted: 04/09/2010] [Indexed: 02/07/2023] Open
Abstract
Hemodynamically significant left main coronary artery stenosis (LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left circumflex artery has no previous patent grafts. Previous randomized studies have demonstrated a significant reduction in mortality when revascularization by coronary artery bypass graft (CABG) surgery was undertaken compared with medical treatment. Therefore, current practice guidelines do not recommend percutaneous coronary intervention (PCI) for such a lesion because of the proven benefit of surgery and high rates of restenosis with the use of bare metal stents. However, with the advent of drug-eluting stents (DES), the long term outcomes of PCI with DES to treat unprotected LMCA stenoses have been acceptable. Therefore, apart from the current guidelines, PCI for treatment of unprotected LMCA stenosis is often undertaken in individuals who are at a very high risk of CABG or refuse to undergo a sternotomy. Future randomized studies comparing CABG vs PCI using DES for treatment of unprotected LMCA stenosis would be a great advance in clinical knowledge for the adoption of appropriate treatment.
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Affiliation(s)
- Seung-Jung Park
- Seung-Jung Park, Young-Hak Kim, Cardiac Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
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Jensen LO, Kaltoft A, Thayssen P, Tilsted HH, Christiansen EH, Mikkelsen KV, Maeng M, Hansen KN, Villadsen AB, Madsen M, Lassen JF, Pedersen KE, Thuesen L. Outcome in high risk patients with unprotected left main coronary artery stenosis treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2010; 75:101-8. [PMID: 19670299 DOI: 10.1002/ccd.22205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We examined mortality, risk of myocardial infarction (MI), and target lesion revascularization (TLR) in high-risk patients with unprotected left main (LM) percutaneous coronary intervention (PCI) in Western Denmark. BACKGROUND PCI of left main coronary artery lesions may be an alternative to coronary artery bypass grafting in high-risk surgical patients. METHODS From January 2005 to May 2007, all patients who had unprotected LM PCI with stent implantation were identified in the Western Denmark Heart Registry. The indications for PCI were: (1) ST segment elevation MI (STEMI), (2) non-STEMI (NSTEMI) or unstable angina, and (3) stable angina. All patients were followed up for 18 months. RESULTS A total of 344 patients were treated with LM PCI (STEMI: 71, NSTEMI/unstable angina: 157, and stable angina: 116). In STEMI patients, the median logistic EuroSCORE was 22.5 (interquartile range 12.5-39.5), in non-STEMI (NSTEMI)/unstable angina patients 13.8 (4.8-23.9), and in stable angina patients 4.8 (2.2-10.4). Mortality after 18 months 38.0, 18.5, and 11.2% (P < 0.001) in patients with STEMI, NSTEMI/unstable angina, and stable angina, respectively. MI after 18 months was 9.9, 6.4, and 6.0% (P = ns), respectively. Four subacute and one late definite stent thrombosis were seen. TLR occurred in 5.6, 4.5, and 6.9% (P = ns) of patients, respectively. CONCLUSION After PCI, patients with STEMI and LM culprit lesion have a high-mortality risk, whereas long-term outcome for patients with NSTEMI and stable angina pectoris is comparable with other high surgical risk patients with unprotected left main lesion. Further, TLR rates and risk of stent thrombosis were low.
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Ferenc M, Gick M, Kienzle RP, Bestehorn HP, Werner KD, Comberg T, Zhao M, Buettner HJ, Neumann FJ. Long-term outcome of percutaneous catheter intervention for de novo coronary bifurcation lesions with drug-eluting stents or bare-metal stents. Am Heart J 2010; 159:454-61. [PMID: 20211309 DOI: 10.1016/j.ahj.2009.11.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 11/25/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to assess the long-term risks and benefits of drug-eluting stents (DESs) compared with bare-metal stents (BMSs) for treatment of coronary bifurcation lesions. METHODS Our registry comprised 1,038 patients treated for coronary bifurcation lesion according to the provisional T-stenting strategy who were followed up for 3 years. RESULTS Target lesion revascularization rates were 24.3% for BMSs (n = 337), 15.6% for sirolimus-eluting stents (SESs, n = 422), and 17.3% for paclitaxel-eluting stents (PESs, n = 279) (P = .003 BMSs vs DESs, P = .54 SESs vs PESs). The respective incidences were 11.4%, 9.5%, and 14.8% (P = .65, P = .13) for death and myocardial infarction and 9.9%, 6.5%, and 10.6% (P = .72, P = .19) for death. Propensity score adjusted hazard ratios (95% CI) for DESs versus BMSs were 0.49 (0.35-0.68, P < .001) for target lesion revascularization, 0.94 (0.64-1.40, P = .078) for death and myocardial infarction, and 0.85 (0.55-1.32, P = .47) for death. We did not find any significant differences between SESs and PESs, except for an increased risk of death after PESs compared with SESs (but not BMSs) in the subgroup receiving a side-branch stent (adjusted hazard ratio 2.45, 95% CI 1.05-5.73, P = .035). CONCLUSIONS Compared with BMSs, both PESs and SESs substantially reduced the long-term need for repeated revascularization but did not increase the risk of death and myocardial infarction.
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Park SJ, Kim YH. Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Stenosis. Cardiol Clin 2010; 28:81-95. [DOI: 10.1016/j.ccl.2009.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Sillano D, Infantino V, Biondi-Zoccai G, Sheiban I. Management of restenosis after drug-eluting stent placement for unprotected left main disease. Interv Cardiol 2010. [DOI: 10.2217/ica.09.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Albarrán A, Mauri J, Pinar E, Baz JA. Actualización en cardiología intervencionista. Rev Esp Cardiol 2010; 63 Suppl 1:86-100. [DOI: 10.1016/s0300-8932(10)70143-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Migliorini A, Valenti R, Marcucci R, Parodi G, Giuliani G, Buonamici P, Cerisano G, Carrabba N, Gensini GF, Abbate R, Antoniucci D. High residual platelet reactivity after clopidogrel loading and long-term clinical outcome after drug-eluting stenting for unprotected left main coronary disease. Circulation 2009; 120:2214-21. [PMID: 19917884 DOI: 10.1161/circulationaha.109.883454] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No data exist about the impact of high residual platelet reactivity (HRPR) after clopidogrel loading on long-term clinical outcome in patients undergoing drug-eluting stent (DES) implantation for unprotected left main disease (ULMD). METHODS AND RESULTS Consecutive patients who underwent percutaneous coronary intervention for ULMD had prospective platelet reactivity assessment by light transmittance aggregometry after a loading dose of 600 mg of clopidogrel. The primary end point of the study was cardiac mortality, and the secondary end point was stent thrombosis. From January 2005 to September 2008, 215 consecutive patients were treated with DES for ULMD. The incidence of HRPR after clopidogrel loading was 18.6%. The median follow-up was 19.3 months. The overall estimated 1-, 2- and 3-year cardiac mortality rate was 3.9+/-1.3%, 7.5+/-2.2%, and 12.2+/-3.4%, respectively. The 3-year cardiac mortality rate was 8.0+/-3.1% in the low residual platelet reactivity (LRPR) group and 28.3+/-10.4% in the HRPR group (P=0.005). The 3-year stent thrombosis rate was 4.2+/-1.8% in the low residual platelet reactivity group and 16.0+/-7.3% in the HRPR group (P=0.021). By forward stepwise regression analysis, HRPR after clopidogrel loading was the only independent predictor of cardiac death (hazard ratio, 3.82; 95% confidence interval,1.38 to 10.54; P=0.010) and stent thrombosis (hazard ratio, 3.69; 95% confidence interval, 1.12 to 12.09; P=0.031). CONCLUSIONS HRPR after 600-mg clopidogrel loading is a strong marker of increased risk of cardiac death and DES thrombosis in patients receiving DES stenting for ULMD. Routine assessment of in vitro residual platelet reactivity after clopidogrel loading in patients with ULMD potentially suitable for DES-supported percutaneous coronary intervention should be considered to guide patient care decisions.
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Affiliation(s)
- Angela Migliorini
- Department of Heart and Vessels, University of Florence, Careggi Hospital, 50134 Florence, Italy
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Buszman PE, Buszman PP, Kiesz RS, Bochenek A, Trela B, Konkolewska M, Wallace-Bradley D, Wilczyński M, Banasiewicz-Szkróbka I, Peszek-Przybyla E, Krol M, Kondys M, Milewski K, Wiernek S, Dębiński M, Żurakowski A, Martin JL, Tendera M. Early and Long-Term Results of Unprotected Left Main Coronary Artery Stenting. J Am Coll Cardiol 2009; 54:1500-11. [PMID: 19699048 DOI: 10.1016/j.jacc.2009.07.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 07/07/2009] [Accepted: 07/12/2009] [Indexed: 10/20/2022]
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Park SJ, Kim YH. Percutaneous coronary intervention for unprotected left main coronary artery stenosis. Interv Cardiol 2009. [DOI: 10.2217/ica.09.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kandzari DE, Colombo A, Park SJ, Tommaso CL, Ellis SG, Guzman LA, Teirstein PS, Tamburino C, Ormiston J, Stone GW, Dangas GD, Popma JJ, Bass TA. Revascularization for Unprotected Left Main Disease. J Am Coll Cardiol 2009; 54:1576-88. [PMID: 19833256 DOI: 10.1016/j.jacc.2009.07.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 07/13/2009] [Accepted: 07/21/2009] [Indexed: 11/26/2022]
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Serruys P, Garg S. Percutaneous coronary interventions for all patients with complex coronary artery disease: triple vessel disease or left main coronary artery disease. Yes? No? Don't know? Rev Esp Cardiol 2009; 62:719-25. [PMID: 19709505 DOI: 10.1016/s1885-5857(09)72350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schulz S, Schuster T, Mehilli J, Byrne RA, Ellert J, Massberg S, Goedel J, Bruskina O, Ulm K, Schomig A, Kastrati A. Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period. Eur Heart J 2009; 30:2714-21. [DOI: 10.1093/eurheartj/ehp275] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Intervencionismo coronario percutáneo para todos los pacientes con enfermedad coronaria compleja: enfermedad de tres vasos o del tronco izquierdo. ¿Verdadero? ¿Falso? ¿No se sabe? Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71683-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Alfonso F. Left Main Coronary Artery Stenting. J Am Coll Cardiol 2009; 53:1769-72. [DOI: 10.1016/j.jacc.2009.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 02/11/2009] [Accepted: 02/16/2009] [Indexed: 11/29/2022]
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Sato Y, Oshida Y, Han YQ, Morishita Y, Li L, Ekberg K, Jörnvall H, Wahren J. C-peptide fragments stimulate glucose utilization in diabetic rats. Cell Mol Life Sci 2004; 61:727-32. [PMID: 15052415 PMCID: PMC11138618 DOI: 10.1007/s00018-003-3460-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Studies of C-peptide cellular effects show that not only the full-length native peptide but also specific C-terminal fragments are biologically active in in vitro systems. In the present study, the effect of five C-peptide fragments and the native peptide on whole-body glucose turnover was studied in streptozotocin diabetic rats using the insulin clamp technique. Insulin was infused intravenously at 18 pmol kg(-1) min(-1) for 90 min and blood glucose concentration was clamped at 8 and 4 mM in diabetic and non-diabetic animals. A steady state was reached during the last 30 min of the study period. Rat C-peptide II and fragments comprising residues 27-31 and 28-31 were effective in augmenting glucose turnover in diabetic rats (+100% to 150%), while no significant effects were seen for segments 1-26, 11-19 and 11-15. The metabolic clearance rate for glucose during infusion of C-peptide or fragments 27-31 and 28-31 in diabetic rats was similar to that seen in non-diabetic animals. We conclude that C-terminal tetra- and pentapeptides, but not fragments from the middle segment of C-peptide, are as effective as the full-length peptide in stimulating whole-body glucose turnover in diabetic rats.
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Affiliation(s)
- Y. Sato
- Research Centre of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
- Department of Sports Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Y. Oshida
- Research Centre of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
- Department of Sports Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Y.-Q. Han
- Department of Sports Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Y. Morishita
- Department of Internal Medicine, Anjyo Kosei Hospital, Anjyo, Japan
| | - L. Li
- Department of Endocrinology, Second University Hospital, China Medical University, Shen Yang, China
| | - K. Ekberg
- Section of Clinical Physiology, Department of Surgical Sciences, Karolinska Hospital N1:05, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - H. Jörnvall
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - J. Wahren
- Department of Endocrinology, Second University Hospital, China Medical University, Shen Yang, China
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