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A comparative analysis of primary stenting and optimal balloon coronary angioplasty in acute myocardial infarction. Six month results from the STENT PAMI trial
Mattos, Luiz Alberto;Grines, Cindy L.;Cox, David;Sousa, J. Eduardo;Costantini, Costantino;Stone, Gregg;Morice, Marie C.;O'Neill, William;Garcia, Eulógio;Boura, Judith;
Arquivos Brasileiros de Cardiologia , 2000, DOI: 10.1590/S0066-782X2000001200004
Abstract: objective: to compare the outcome of balloon ptca with final coronary stenosis diameter (sd) £30%, with elective coronary stenting. methods: we performed a comparative analysis of the 6 month outcomes in patients treated with primary stenting and those who obtained an optimal balloon ptca result treated during the first 12 hours of ami onset included in the stent pami randomized trial.results: the results were analysed into 3 groups: primary stenting (441 patients, sd=22±6%), optimal ptca (245 patients), and nonoptimal ptca (182 patients, sd= 37±5%). at the end of the 6 months primary stent group presented with the lowest restenosis(23 vs. 31 vs. 45%, p=0.001, respectively). ischemia-driven target vessel revascularization rate (tvr) (7 vs. 15.5 vs. 19%, p=0.001, respectively). conclusion: at the 6 month follow-up, primary stenting offered the lowest restenosis and ischemia-driven tvr rates. compared to optimal balloon ptca. nonoptimal primary balloon ptca pts (sd=31-50%), had the worst late angiographic outcomes and should be treated more actively with coronary stent implantation.
A comparative analysis of primary stenting and optimal balloon coronary angioplasty in acute myocardial infarction. Six month results from the STENT PAMI trial
Mattos Luiz Alberto,Grines Cindy L.,Cox David,Sousa J. Eduardo
Arquivos Brasileiros de Cardiologia , 2000,
Abstract: OBJECTIVE: To compare the outcome of balloon PTCA with final coronary stenosis diameter (SD) <=30%, with elective coronary stenting. METHODS: We performed a comparative analysis of the 6 month outcomes in patients treated with primary stenting and those who obtained an optimal balloon PTCA result treated during the first 12 hours of AMI onset included in the STENT PAMI randomized trial. RESULTS: The results were analysed into 3 groups: primary stenting (441 patients, SD=22±6%), optimal PTCA (245 patients), and nonoptimal PTCA (182 patients, SD= 37±5%). At the end of the 6 months primary stent group presented with the lowest restenosis(23 vs. 31 vs. 45%, p=0.001, respectively). Ischemia-driven target vessel revascularization rate (TVR) (7 vs. 15.5 vs. 19%, p=0.001, respectively). CONCLUSION: At the 6 month follow-up, primary stenting offered the lowest restenosis and ischemia-driven TVR rates. Compared to optimal balloon PTCA. Nonoptimal primary balloon PTCA pts (SD=31-50%), had the worst late angiographic outcomes and should be treated more actively with coronary stent implantation.
Clopidogrel resistance "Live" – the risk of stent thrombosis should be evaluated before procedures
Zuzana Motovska, Petr Widimsky, Iuri Marinov, Robert Petr, Jaroslava Hajkova, Jan Kvasnicka, the PRAGUE-8 study Investigators
Thrombosis Journal , 2009, DOI: 10.1186/1477-9560-7-6
Abstract: Every year, millions of people undergo percutaneous coronary intervention (PCI) with intracoronary stent implantation. Dual antiplatelet therapy – aspirin plus clopidogrel – is recommended for the reduction of acute and subacute stent thrombosis [1,2]. Despite combined antiplatelet therapy, stent thrombosis persists at a rate of 0.5–2% in elective cases, and up to 6% in patients with acute coronary syndromes [3]. Stent thrombosis is a life-threatening event [4]. In addition, also in cases of immediate reperfusion therapy by means of emergency PCI, patients with stent thrombosis have developed a major myocardial infarction, with consequent significant decline in left ventricular function – a strong negative predictor of long-term survival [3]. "Retrospective" laboratory testing in patients with stent thrombosis has shown that poor response ("resistance") to antiplatelet therapy is a risk factor for this event [5-7].A 67-year old woman was admitted to Cardiocentre for an elective coronary angiography, because of changes on the ECG (new negative T waves in leads I, aVL, V1-V3) and new anteroapical hypokinesis seen by echocardiography. She was a cigarette smoker, with a history of diabetes, hypertension, hypercholestrolemia on statin therapy (atorvastatin), and with known coronary artery disease on aspirin. The patient fulfilled the inclusion criteria of the PRAGUE-8 trial (see section methods) [8]. After signing of informed consent, she was randomized into group B of this study, and also participated in the vasodilator stimulated phosphoprotein (VASP) phosphorylation state and genetic laboratory substudies. In the laboratory substudy, the time course of platelet inhibition after clopidogrel (600 mg loading dose followed by 75 mg per day) was investigated.On the second day of hospitalization, the patient underwent a coronary angiography, which showed an 80% stenotic lesion on her left anterior descending artery. The lesion was treated with ad hoc performed PCI with the
Primary coronary angioplasty and stent implantation in acute myocardial infarction. Comparative analysis of the in-hospital results in the CENIC/SBHCI registry
Mattos, Luiz Alberto;Sousa, Amanda G. M. R.;C. Neto, Cantídeo;Labrunie, André;Alves, Cláudia R.;Saad, Jamil;
Arquivos Brasileiros de Cardiologia , 1999, DOI: 10.1590/S0066-782X1999001200002
Abstract: objective: comparative analysis of the in-hospital results after primary implantation of stents or coronary balloon angioplasty in patients with acute myocardial infarction (mi). methods: cenic (national center of cardiovascular interventions) gathered data on 3,924 patients undergoing coronary angioplasty (in the primary form, without the previous use of thrombolytic agents) in the first 24 hours after a mi, during the period of 1996-1998. from these 3,924 patients, 1,337 (34%) underwent stent implantation. we analyzed the success of the procedure and the occurrence of adverse cardiac events. results: in patients undergoing stent implantation there were more males (77% vs 69%, p=0.001), previous by pass surgery (6.3% vs. 4.5%, p=0.01), anterior mi and stent implantation in left descending artery (55% vs. 48% vs. p=0.009), and saphenous vein bypass grafts (3.3% vs. 1.9%). the procedure was more succesful in the group of stents (97% vs. 84%, p=0.001) and reinfarction rate (2.5 vs. 4%, p=0.002). the need for emergency revascularization was similar (1% vs. 1.1%, ns). total in-hospital mortality was lower in stent group (3.4% vs. 7. 2%, p=0.0001) and this effect was in patients killip class iii/v (19.5% vs. 32.5%, p= 0.002) because there was no difference in patients class i/ii (1.7% vs. 2.8%, p=0.9). conclusion: primary stent implantation in acute myocardial infarction showed better early results than balloon angioplasty alome.
Primary coronary angioplasty and stent implantation in acute myocardial infarction. Comparative analysis of the in-hospital results in the CENIC/SBHCI registry  [cached]
Mattos Luiz Alberto,Sousa Amanda G. M. R.,C. Neto Cantídeo,Labrunie André
Arquivos Brasileiros de Cardiologia , 1999,
Abstract: OBJECTIVE: Comparative analysis of the in-hospital results after primary implantation of stents or coronary balloon angioplasty in patients with acute myocardial infarction (MI). METHODS: CENIC (National Center of Cardiovascular Interventions) gathered data on 3,924 patients undergoing coronary angioplasty (in the primary form, without the previous use of thrombolytic agents) in the first 24 hours after a MI, during the period of 1996-1998. From these 3,924 patients, 1,337 (34%) underwent stent implantation. We analyzed the success of the procedure and the occurrence of adverse cardiac events. RESULTS: In patients undergoing stent implantation there were more males (77% vs 69%, p=0.001), previous by pass surgery (6.3% vs. 4.5%, p=0.01), anterior MI and stent implantation in left descending artery (55% vs. 48% vs. p=0.009), and saphenous vein bypass grafts (3.3% vs. 1.9%). the procedure was more succesful in the group of stents (97% vs. 84%, p=0.001) and reinfarction rate (2.5 vs. 4%, p=0.002). The need for emergency revascularization was similar (1% vs. 1.1%, NS). Total in-hospital mortality was lower in stent group (3.4% vs. 7. 2%, p=0.0001) and this effect was in patients Killip class III/V (19.5% vs. 32.5%, p= 0.002) because there was no difference in patients class I/II (1.7% vs. 2.8%, p=0.9). CONCLUSION: Primary stent implantation in acute myocardial infarction showed better early results than balloon angioplasty alome.
An unusual case of ST-segment elevation myocardial infarction following a late bare-metal stent fracture in a native coronary artery: a case report
Giovanni Minardi, Paolo G Pino, Marco Nazzaro, Herribert Pavaci, Martina Sordi, Cesare Greco, Carlo Gaudio
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-9296
Abstract: We present, to the best of our knowledge, the first documented case of ST-segment elevation myocardial infarction in a patient following a late bare-metal stent fracture and thrombosis in a native coronary artery. The patient, a 51-year-old Caucasian man, was treated successfully with primary percutaneous coronary intervention and a new stent implantation.A coronary stent fracture is a rare complication that has been described in venous bypass grafts deploying either a drug-eluting stent or a bare-metal stent. Stent fractures rarely occur in coronary arteries. In light of the non-specific presentation of stent fracture, it is also an easily missed complication. Patients may present with a non-specific symptom of angina. The angina could either be stable or unstable as a result of restenosis or in-stent thrombosis, or both. Our case demonstrates the most severe consequences of a bare-metal stent fracture (sudden coronary thrombosis and subsequent myocardial infarction) in a native coronary artery. It was diagnosed angiographically and treated early and effectively.A bare-metal stent (BMS) fracture as a cause of acute coronary thrombosis and consequently of acute coronary syndrome (ACS) is a rare clinical event that, to the best of our knowledge, has previously not been reported.A stent fracture is a rare complication of percutaneous coronary intervention (PCI). Drug-eluting stent (DES) fractures have an estimated incidence of 2.7% [1], and a BMS fracture in a saphenous vein graft has recently been described [2]. A late BMS fracture has also been reported, which was detected by 64-slice multidetector computed tomography (MDCT) [3].A 51-year-old Caucasian man who smoked and was afflicted with dyslipidemia presented at our emergency department complaining of typical angina and shortness of breath. He had a family history of coronary artery disease. He had been successfully treated with coronary angioplasty 12 years before presentation. A 4.0/16.0 mm AVE Micro stent (AVE
Very Late Stent Thrombosis 42 Months after Implantation of Sirolimus-Eluting Stent and Discontinuation of Antiplatelet Therapy
Dirk Sibbing,Karl-Ludwig Laugwitz,Lorenz Bott-Flügel,Jürgen Pache
Case Reports in Medicine , 2009, DOI: 10.1155/2009/713292
Abstract: Although safety profiles of sirolimus-eluting stents do not seem to differ in short-to-medium term from those of bare-metal stents, late stent thrombosis after deployment of drug-eluting stents has emerged as a potential safety concern in the era of high-pressure stent implantation. Here, we describe the case of a patient with acute myocardial infarction due to stent thrombosis of a sirolimus-eluting stent 42 months after stent deployment and 5 weeks after discontinuation of aspirin treatment. To the best of our knowledge, this is one of the most delayed cases of sirolimus-eluting stent thrombosis described so far. The case emphasizes the potential risk that late stent thrombosis can unpredictably occur at any time point after drug-eluting stent deployment.
Recurrent myocardial infarction after very late
Ali Ghaemian,Rozita Jalalian,Joren Marjani
Journal of Mazandaran University of Medical Sciences , 2009,
Abstract: (Received 29 Sep, 2008 ; Accepted 14 Feb, 2009)AbstractStent thrombosis as a complication of percutaneous coronary intervention frequently is associated with deadly events such as myocardial infarction and sudden death.Definitions of stent thrombosis have not been in a uniform manner in different clinical studies.Two episodes of acute ST elevation myocardial infarction nearly two years after implanting a drug – eluting stent in a 58-year-old male patient is reported here .The presence of stent thrombosis was confirmed by coronary angiography.
Evaluation of coronary plaque and stent deployment by intravascular optical coherence tomography in elderly patients with unstable angina and non-ST-elevation myocardial infarction
Caiyi LU,Shiwen WANG,Wei YAN,Xingli WU,Yuxiao ZHANG,Qiao XUE,Muyang YAN,Peng LIU,Rui CHEN,Jinyue ZHAI,
Caiyi LU
,Shiwen WANG,Wei YAN,Xingli WU,Yuxiao ZHANG,Qiao XUE,Muyang YAN,Peng LIU,Rui CHEN,Jinyue ZHAI

老年心脏病学杂志(英文版) , 2007,
Abstract: Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography (OCT) in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with unstable angina (UA) and non-ST segment elevation myocardial infarction (NSTEMI). Methods OCT was used in elderly patients undergoing percutaneous coronary interventions. Fifteen patients, 9 males and 6 females with mean age of 72.6±5.3 years (range 67-92 years) were enrolled in the study. Images were obtained before initial balloon dilatation and following stent deployment. The plaque characteristics before dilation, vessel dissection, tissue prolapse, stent apposition and strut distribution after stent implantation were evaluated. Results Fifteen lesions were selected from 32 angiographic lesions as study lesions for OCT imaging after diagnostic coronary angiography. There were 7 lesions in the left anterior descending artery, 5 lesions in the right coronary artery and 3 lesions in the left circumflex coronary artery. Among them, 12 (80.0%) were lipid-rich plaques, and 10 (66.7%) were vulnerable plaques with fibrous cap thickness 54.2±7.3 |im. Seven ruptured culprit plaques (46.7%) were found; 4 in UA patients and 3 in NSTEMI patients. Tissue prolapse was observed in 11 lesions (73.3%). Irregular stent strut distribution was detected in 8 lesions (53.3%). Vessel dissections were found in 5 lesions (33.3%). Incomplete stent apposition was observed in 3 stents (20%) with mean spacing between the struts and the vessel wall I72±96 mm (range 117-436 mm). Conclusions 1) It is safe and feasible to perform intravascular OCT to differentiate vulnerable coronary plaque and monitor stent deployment in elderly patients with UA and USTEMI. 2) Coronary plaques in elderly patients with UA and USTEMI could be divided into acute ruptured plaque, vulnerable plaque, lipid-rich plaque, and stable plaque. 3) Minor or critical plaque rupture is one of the mechanisms of UA in elderly patients. 4) Present drug eluting stent implantation is complicated with multiple tissue prolapses which are associated with irregular strut distributions. 5) The action and significance of tissue prolapse on acute vessel flow and in-stent thrombus and restenosis need to be further studied.
Late stent thrombosis  [PDF]
Petrovi? Milovan,Bikicki Miroslav,Pani? Gordana,?anji Tibor
Medicinski Pregled , 2009, DOI: 10.2298/mpns0902079p
Abstract: Introduction. Late stent thrombosis is a serious complication after stent Implantation and it can lead to the development of acute myocardial infarction or death. A case report. A 43-year-old patient was admitted to our clinic to coronary care unit. He was diagnosed with acute ST elevation myocardial reinfarction of inferoposterior localisation and with right ventricular myocardial infarction. Eighteen months ago, he had acute myocardial infarction of the same localisation, and at the same time, PCI (Percutaneous Coronary Intervention) was performed in acute phase, and two bare metal stents were implanted. Now, the patient had chest discomfort two hours before admittance, and PCI was performed once again in acute phase. The diagnostic coronarography resulted in occlusion of the right coronary artery, on the spot of the previously implanted stents. After the passage of guidewire, the artery was recanalized, and defects of artery opacification, which might have been thrombs, were noticed. The thrombs were seen on the spots of earlier implanted stents and in the posterior inteventricular and posterolateral branches of the right coronary artery. PTCA was performed and the patient received the GP IIb/IIIa antagonist therapy after which the control coronarography showed minimal defects of artery opacification, with good anterograde flow. After complete treatment the patient was in good condition. Conclusion. Late stent thrombosis, although not very often, is a very serious complication and can lead to death or acute myocardial infarction. To prevent it, it is necessary that the patient receives dual antiplatelet therapy, and that PCI procedure is performed technically correctly (suitable stent dimensions and proper stent expansion).
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