BACKGROUND EDG (endothelial differentiation gene)-2 is a membrane receptor for LPA (lysophosphatidic acid) which is the major lysophospholipid growth factor generated by platelet activation. We foc...
Background The SYNTAX score (SS) and clinical SS (cSS) are widely used to assess coronary lesion complexity, and are useful indices in predicting outcomes after percutaneous coronary intervention. However, SS was derived from a study that exclusively used paclitaxel eluting stents, and its applicability to patients receiving ‘limus’ eluting stents is unclear. Thus, we investigated the validity of the SS and cSS in predicting clinical outcomes from a cohort where ‘limus’ stents were used unrestrictedly. We also compared the predictability of the scores in everolimus eluting stents (EES) versus sirolimus eluting stents (SES). Methods Patients were from the Efficacy of Xience/Promus versus Cypher in rEducing Late Loss after stenting (EXCELLENT) registry and the SS was evaluated at an independent angiographic core lab. The 1-year patient oriented composite endpoint (POCE) (all cause death, any myocardial infarction (MI), and any revascularization) and target lesion failure (TLF) (cardiac death, target vessel MI, and target lesion revascularization) were the major analysis endpoints. The area under the curve (AUC) of a receiver operating characteristic was used as the predictability of SS and cSS. Results Among 5102 patients (7003 lesions) enrolled, 3047 patients (4235 lesions) received EES and 2055 patients (2768 lesions) received SES. Tertiles for SS were defined as low SS<8, 8≤mid SS≤16, high SS>16. From the whole population, both POCE (4.2% vs. 7.7% vs. 12.2%, p<0.001) and TLF (1.6% vs. 2.4% vs. 4.5%, p<0.001) increased significantly along with increasing SS tertiles, and SS was an independent predictor of POCE and TLF in multivariate analysis (p<0.001 for all) The predictability of SS and cSS was similar for POCE (AUC: 0.635 vs. 0.629, for SS vs. cSS, p=0.599) but cSS was superior to SS in predicting TLF (AUC: 0.625 vs. 0.680, for SS vs. cSS, p=0.008). When stratified according to each stent, higher SS tertiles were significantly associated with increased risk of POCE and TLF in both EES and SES. Conclusion Both SS and cSS were applicable to unrestricted use of ‘limus’ stents to predict the risk of 1-year adverse clinical outcomes. The predictability of SS and cSS was similar for POCE but the inclusion of clinical variables improved predictability of the SS for TLF.
Background: Previous studies have reported possible predictors of drug-eluting stent thrombosis (ST), but data for Asians are relatively limited. This study was performed to elucidate clinical predictors of ST in Koreans. Methods and Results: From May 2003 to May 2007, consecutive patients presenting with ST were enrolled from 10 cardiovascular centers in Korea. They were compared with 2,192 controls (3,223 lesions) who had received percutaneous coronary intervention with at least 6 months of follow-up without ST. On multivariate analysis, acute myocardial infarction (AMI) as initial diagnosis, drug-eluting stents (DES) in-stent restenosis (ISR), low ejection fraction (EF), small stent diameter, left anterior descending artery intervention, and young age were independent predictors of total ST. When divided into early (ST within 30 days of index procedure) and delayed ST (ST after 30 days of index procedure), low EF, small stent diameter, DES ISR and AMI as initial diagnosis were universal risks for both early and delayed ST. The time from antiplatelet agent discontinuation to ST occurrence was significantly shorter in late compared with very late ST. Conclusions: Predictors of ST may be slightly different for early vs. delayed ST. However, low EF, small stent diameter, DES ISR lesion, and AMI as initial diagnosis were universal risk factors for both early and delayed ST cases. The relationship between antiplatelet agent discontinuation and ST occurrence seems stronger in late compared with very late ST. (Circ J 2011; 75: 1626-1632)
Introduction Though the efficacy on traditional lipid parameters of simvastatin/ezetimibe and atorvastatin has been studied extensively, ApoB/ApoA1 ratio which has better predictive value for cardiovascular event has not been compared as a primary endpoint in these two treatment groups before, especially in diabetes. Methods This study was a single center, open label, randomized phase 4 study to compare the efficacy and safety of simvastatin/ezetimibe 20/10mg versus atorvastatin 20mg once daily in subjects with type 2 diabetes. One hundred thirty-two well controlled diabetic patients (HbA1C <8.5%) with high LDL cholesterol levels (≥ 100mg/dL) were randomized to two groups. The primary endpoint was the difference in percent change of ApoB/ApoA1 ratio at 12 weeks and secondary endpoints were changes in conventional lipid profiles and apolipoproteins. Results In total, 132 patients (66 for each group; 60 males; mean age, 64.6±7.6 years) were enrolled and 125 patients were included in the full analysis set (62 for simvastatin/ezetimibe; 63 for atorvastatin). Baseline characteristics including lipid profiles were comparable between two groups. After 12 weeks of treatment ApoB/ApoA1 ratio was significantly reduced in both groups, however the differences of % changes between two groups were statistically not significant (-38.1±17.9% vs. -34.2±16.2%, p =0.279) and the changes in conventional lipid profiles including total cholesterol, LDL cholesterol and triglyceride also showed no significant difference. However, HDL cholesterol and ApoA1 levels increased significantly in the simvastatin/ezetimibe group, whereas decreased in the atorvastatin group (HDL cholesterol 4.2±12.7% vs. -0.2±14.8% and ApoA1 2.8±10.0% vs. -1.8±9.8%, p =0.041 and 0.002). In per-protocol analysis, improvement of ApoB/ApoA1 was significantly greater in the simvastatin/ezetimibe group (-42.3±11.9% vs. -36.5±14.1%, p =0.031). The changes of HOMA index and hsCRP were comparable between two groups in full analysis set. But in per-protocol analysis, HOMA index and hsCRP decreased in the simvastatin/ezetimibe group whereas increased in the atorvastatin group although there was no statistic significance. The frequency of adverse reaction was comparable between two groups. Conclusion Based on the results of this randomized controlled trial, simvastatin/ezetimibe 20/10mg might be preferable to atorvastatin 20mg for management of dyslipidemia in the patients with type 2 diabetes.
Stent thrombosis is generally a fatal complication after percutaneous coronary intervention. Combined antiplatelet therapy is recommended to prevent stent thrombosis in those patients who have undergone stenting. However, there are conflicting opinions on the appropriate duration of instituting antiplatelet treatment, especially after intracoronary radiation therapy or drug-eluting stent implantation, which are two situations closely associated with an increased risk of stent thrombosis. We report here on 2 cases of late stent thrombosis that occurred despite giving combined antiplatelet therapy, and these maladies developed more than 4 years after intracoronary brachytherapy. (Korean Circulation J 2006;36:324-327)
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