Association of Major Adverse Cardiac Events up to 5 Years in Patients With Chest Pain Without Significant Coronary Artery Disease in the Korean Population.

Background Significant coronary artery disease has a well-known association with long-term adverse cardiovascular events. In this study, we aimed to evaluate its association with long-term major adverse clinical events ( MACE ) up to 5 years in patients who presented with chest pain without significant coronary artery disease . Methods and Results A total of 5890 subjects with chest pain without significant coronary artery disease were prospectively enrolled in this study. The mean follow-up duration was 3.4 years. Multivariable Cox proportional hazards regression analysis was performed for assessing the independent risk factors for MACE or sustained angina pectoris. MACE was defined as the composite of total death, myocardial infarction, coronary revascularization, stroke, and hospitalization because of heart failure. Ninety-one (2.2%) patients developed MACE , and 309 (8.1%) patients developed sustained angina pectoris , both within 5 years. In multivariable Cox proportional hazards regression analysis, the risk of MACE was significantly associated with age (per 5 years; hazard ratio [ HR ], 1.44; 95% CI , 1.30-1.60) and insignificant coronary stenosis (30%-70%; HR, 2.03; 95% CI; 1.28-3.21). The risk of sustained angina pectoris was significantly associated with age (per 5 years; HR, 1.05; 95% CI, 1.01-1.11), dyslipidemia ( HR, 1.34; 95% CI , 1.06-1.70), insignificant coronary stenosis ( HR, 2.54; 95% CI , 1.94-3.31), coronary artery spasm (HR, 1.42; 95% CI , 1.11-1.80), and myocardial bridge (HR, 1.37; 95% CI , 1.04-1.81). Conclusions In patients without significant CAD , aging and insignificant coronary stenosis have a strong association with future long-term MACE . Also, aging, dyslipidemia, insignificant coronary stenosis , coronary artery spasm, and myocardial bridge are strongly associated with future angina pectoris .

Impact of insulin resistance on 1-year clinical outcomes in non-diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents.

BACKGROUND: Insulin resistance (IR) is known to be a risk factor for coronary artery disease (CAD). We aimed to evaluate the impact of IR on 1-year clinical outcomes in non-diabetic CAD patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). METHODS AND RESULTS: A total of 229 consecutive non-diabetic CAD patients treated with DESs were enrolled. Study population was divided into IR group [homeostasis model assessment (HOMA) index ≥ 2.5, n=54] and non-IR group (HOMA index<2.5, n=175). Baseline clinical and procedural characteristics were similar between the groups except higher incidence of high-sensitivity C-reactive protein and lower incidence of multivessel disease as the target vessel in the non-IR group. There was a trend toward longer restenosis lesion length in the IR group at 6 months angiographic follow up but composite major clinical outcomes up to 1 year were similar between the two groups. CONCLUSIONS: Despite worse trend in angiographic outcomes in the IR group (HOMA index ≥ 2.5), it was not translated into worse 1-year major clinical outcomes following PCI with DESs as compared to the non-IR group.

Incidence and clinical impact of fracture of drug-eluting stents widely used in current clinical practice: comparison with initial platform of sirolimus-eluting stent.

BACKGROUND: Almost all data on drug-eluting stents (DES) fracture have been derived from initial platform of first-generation DES such as Cypher Bx® (CBX) and Taxus Express®. However, incidence and clinical impact of fracture of newer DES platforms (including Cypher Select®, Taxus® Liberté™, Endeavor®, and Xience™ V) that have been used widely in current clinical practice have not yet been studied. METHODS AND RESULTS: We analyzed data of 1518 lesions treated with the newer DES platforms in patients who underwent follow-up coronary angiography and compared the results with those of 622 lesions treated with the CBX. The group of newer DES platforms showed significantly lower incidence of stent fracture (SF) than the CBX group (1.25% vs. 5.8%, p<0.001). Binary restenosis (42.1% vs. 6.6%, p<0.001) and target lesion revascularization (TLR) (47.3% vs. 6.2%, p<0.001) related to SF in the newer DES platforms' group were significantly higher than those not related to SF. Notably, SF-related binary restenosis (42.1% vs. 36.1%, p=0.52) and TLR (47.3% vs. 41.6%, p=0.2) were similar between the newer DES platforms' group and the CBX group. On multivariable logistic regression analysis, lesion angulation>45° (odds ratio [OR]: 7.6; 95% confidence interval [CI]: 2.2-26.31), RCA stenting (OR: 5.14; 95% CI: 1.62-16.3) and total stent length (OR: 1.18; 95% CI: 1.03-1.33) were identified as independent predictors for fracture of the newer DES platforms, while closed-cell design stent (Cypher Select®) was not. CONCLUSIONS: Although implantation of the newer DES platforms might reduce the occurrence of SF compared with the CBX, SF-related binary restenosis and TLR remain similarly high. And to predict SF in the newer DES platforms' era, lesion characteristics on index procedure are more important than implanted stent design.