Evaluation of stent length on the outcome of ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention
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A longer stent length is known to be a predictor of adverse events after a percutaneous coronary intervention (PCI). However, the evaluation of the stent length on the outcome of ST-segment elevation myocardial infarction (STEMI) patients is not enough.A total of 686 STEMI patients who underwent primary PCI were divided into four groups according to the total stent length as follows: short (<18 mm, n=183), lower-medium (18-23 mm, n=256), upper-medium (24-31 mm, n=155), and long (≥32 mm, n=92). We compared the all-cause mortality, major adverse cardiovascular events (MACEs; composite of cardiovascular death, myocardial infarction, and stroke after discharge), target lesion revascularization, and target vessel revascularization with a median follow-up of 1213 days among these four groups.There were no significant differences in MACEs (10.4% in the short, 7.0% in the lower-medium, 6.5% in the upper-medium, 7.6% in the long, P=0.633) among the different stent length groups. The all-cause mortality, target lesion revascularization, and target vessel revascularization also did not differ among the four groups. In the drug-eluting stent (n=237) and bare-metal stent subgroups (n=449), all outcomes were comparable among the groups. However, in the diabetes subgroup (n=265), the rate of MACEs was higher in the long group than in the other groups, although the difference was not significant (6.6% in the short, 9.6% in the lower-medium, 3.4% in upper-medium, 16.7% in long group, P=0.095).A long stent length was not associated with adverse clinical outcomes in STEMI patients who underwent primary PCI.Keywords:
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PCIに関するこれまでの報告をreviewすることにより, 小細胞肺癌 (SCLC) に対する予防的脳照射 (PCI) の有用性を検証する. 結果. 1970年代より1980年代にかけて多くの比較試験が行われ, PCIによる脳転移の抑制効果が示されたが, 生存への有意な寄与を証明した報告はなく, またPCIによる遅発性の神経障害の可能性なども報告され, この時点ではSCLCに対するPCIの意義は確立されたものではなかった. その後Auperinらは, 7つの比較試験のメタアナリシスを行うことにより, CR例ではPCIにより脳転移の抑制のみならず, 生存率の有意な改善効果 (3年生存率: 20.7% vs 15.3%, P=0.01) が得られることを証明した. 一方, Arriagada, Gregorらの比較試験では, PCI群と非PCI群との間に精神, 神経症状, CT scanにおける脳萎縮の発現頻度などに差を認めなかった. 結論. 導入療法によりCRが得られたSCLC症例に対してPCIは行うべきであるが, 今後解決すべき課題としてPCIの線量, 分割用式, タイミング, および遅発性の有害反応の検討などが残されている.
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Abstract Background/purpose Percutaneous coronary intervention (PCI) of diffuse coronary artery disease (CAD) is associated with higher adverse clinical events. This study aimed to compare the clinical outcomes of patients treated with single long 48 mm contemporary drug eluting stents (SL-DES) versus two overlapping contemporary drug eluting stents (OL-DES) for very-long CAD. Methods/materials We analyzed the clinical outcome of 117 patients with SL-DES and 101 patients with OL-DES who underwent PCI between 1st July 2013 to 31st December 2016. The primary endpoint was target lesion failure (TLF) at two years, defined as a composite of cardiac mortality, target vessel myocardial infarction and target lesion revascularization. Results Mean age was 60.8 ± 10.5 years for SL-DES group and 60.5 ± 11.9 years in the OL-DES group. SL-DES has longer mean lesion length as compared to OL-DES (43.1 ± 3.7 mm vs. 41.83 ± 2.3 mm p = 0.003). There was no difference in TLF at two years between SL-DES and OL-DES (5.3% vs. 6.4%, adjusted odds ratio 1.43, 95% CI 0.50–4.11). There was one case of probable ST in each group. Contrast volume usage was lower for SL-DES than OL-DES in patients who underwent single vessel PCI. Conclusions Treatment of very-long CAD showed comparable TLF at two years for SL-DES versus OL-DES. Our results suggest that both strategies are reasonable treatment options for patients with diffuse CAD.
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Objective To investigate the outcome prediction of BNP and ST segment to LV remodeling(LVRM) by observing the relation of the changes of ST segment in electrocardiograms and plasma BNP in cases with AMI after PCI operation with LVRM.Methods Forty-eight patients with a first AMI treated with primary PCI were selected.The extent of the ST segment elevation and resolution in electrocardiograms on admission and one hour after PCI was analyzed.All the patients were divided into two groups according to the extent of ST segment elevation and resolution.Group A:resolution of ST segment elevation≧50%,n=37;Group B:resolution of ST segments elevation50%,n=11;Plasma BNP levels was measured with eletrochemistry luminescent technique before PCI and at 7 days after PCI;echocardiogram was checked at 2～3 days and 3 months after AMI.Results With PCI treatment,the plasma BNP levels in group A decreased significantly vs in group B;in group A,the plasma BNP levels after treatment decreased significantly vs before treatment;on the contrary in group B.In group A,there was no significant difference of LVEDD between at 2～3 days after PCI and at 3 months after PCI;in group B,LVEDD at 3 months after PCI increased significantly vs that at 2～3 days after PCI;the rate of LVRM in group B was bigger than that in group A.Conclusion The persist elevation of ST segment and the plasma BNP levels after PCI in AMI patien is clinically important for predicting the LVRM.
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