The impact of renal function on the long-term clinical course of patients who underwent percutaneous coronary intervention.

OBJECTIVES: To determine the impact of the level of kidney function on the extended (>5 years) long-term clinical course of patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: Chronic kidney disease (CKD) has been significantly associated with an increased in-hospital and 1-year mortality following PCI. METHODS: In this single-centre retrospective study, glomerular filtration rate (GFR) at baseline was estimated in 371 patients not on dialysis, who underwent successful PCI between mid-1995 and mid-1999. Baseline demographic and angiographic characteristics, and long-term major adverse cardiac events and symptoms were compared for patients with GFR > or =60 ml/min/1.73 m(2) (normal or mildly impaired renal function) and GFR > or = 60 ml/ min/1.73 m(2) (CKD). The independent effect of GFR, modelled both as a categorical and a continuous variable, on long-term clinical outcomes was also investigated using multivariate Cox regression analysis. RESULTS: Nine-year all-cause and cardiac mortality rates were significantly higher in the CKD group (45.9% vs. 10.6%, P < 0.0001 and 35.4% vs. 7.1%, P < 0.0001 respectively), while there was no difference in the repeat revascularization (P = 0.27) and nonfatal Q-wave myocardial infarction (P = 0.74) rates. Multivariate analysis demonstrated an independent impact of the level of GFR on long-term mortality; adjusted 9-year all-cause and cardiac mortality increased by approximately 16% and 11%, respectively for a decrease of GFR from 120 to 60 ml/min/1.73 m(2) and by approximately 14% and 9%, respectively for a decrease of GFR from 60 to 30 ml/min/1.73 m(2). CONCLUSIONS: The level of renal function is a strong determinant of long-term all-cause and cardiac mortality after successful PCI.

Long-term clinical outcome after percutaneous transluminal coronary angioplasty with provisional stenting.

OBJECTIVES: This study reports the 9-year clinical outcome of 409 consecutive patients, who underwent coronary angioplasty with provisional stenting during the years 1995 to 1999 in the University Hospital of Northwestern Greece. BACKGROUND: Despite the rapid changes of interventional cardiology, long-term follow-up studies are useful for identifying its limitations and indicating future changes. METHODS: Baseline characteristics and information on survival, major cardiac events and symptoms were retrospectively obtained from medical records or telephone contact. Patient survival rates were calculated and predictive factors for survival and cardiac events were identified. RESULTS: Follow-up information was obtained in 403 patients (98.5%). Three hundred and thirty-one patients (82%) were alive with 150 (45%) being symptom free. The cumulative 5- and 9-year survival rates were 87% and 78% respectively, and the corresponding survival free from major adverse cardiac events was 65% and 55%. Independent factors affecting survival were age>65 years, diabetes, hypertension, multivessel disease and ejection fraction<50%, while stenting and the indication of acute myocardial infarction for intervention influenced independently survival from cardiac death. Non-diabetics, aged

One year effectiveness of BiodivYsio dexamethazone-eluting stent compared to BiodivYsio stent implantation in the treatment of single vessel coronary artery disease.

OBJECTIVE: To investigate the impact of BiodivYsio dexamethazone-eluting stent versus BiodivYsio stent on the 12-month outcomes after revascularisation of patients with single vessel coronary artery disease. METHODS: From March 2003 to February 2004, 102 patients with non-ST elevation acute coronary syndromes, angina or silent ischemia after recent ST elevation myocardial infarction (<1 month) or stable angina pectoris, and single-vessel coronary artery disease were treated solely with dexamethazone-eluting stent implantation in our institution. Patients were followed up prospectively for twelve months. We compared their outcomes to a control group with similar clinical and angiographic characteristics of 160 patients treated solely with BiodivYsio stents in the preceding study enrolment period (January 2002 to March 2003). RESULTS: Approximately 85% of the patients in both groups were treated after an acute coronary syndrome. At 12 months, the major adverse cardiac events rates (death or non-fatal myocardial infarction or target lesion revascularization) were similar in the 2 groups (10.8% in the dexamethazone-eluting and 11.3% in the BiodivYsio group, p=1.00). No difference was found in the individual rates of death, non-fatal myocardial infarction and target lesion revascularization between the 2 groups. CONCLUSIONS: We conclude that utilization of dexamethazone-eluting stents has no effect in reducing the incidence of major adverse cardiac events after 12 months, as compared with BiodivYsio stent implantation in the treatment of single vessel coronary artery disease.

A prospective randomized trial comparing the safety and efficacy of three commercially available closure devices (Angioseal, Vasoseal and Duett).

PURPOSE: We compared the safety and efficacy of three closure devices (Angioseal, Vasoseal and Duett) used to close arterial puncture sites in patients who underwent coronary percutaneous procedures. METHODS: A prospective randomized, single-center trial was carried out of consecutive patients who underwent coronary angiography [705 patients: Angioseal (243),Vasoseal (228) and Duett (234)] or angioplasty [146 patients:Angioseal (47), Vasoseal (52) and Duett (47)]. RESULTS: In the angiography patients the device deployment rates were similar, with the Angioseal been significantly slower in achieving hemostasis (p = 0.0001) but resulting in earlier ambulation (p = 0.0001). In the coronary angioplasty patients the deployment rates were similar to those for angiography: time to hemostasis was longer for the Angioseal (p = 0.003), while ambulation times were not different, although prolonged compared with angiography (p = 0.0001). The three devices had similar major complication rates. The Vasoseal had a higher major complication rate after angioplasty than after angiography (p = 0.004). The incidence rate of peripheral embolization was lower when the Angioseal was utilized. Severe complications were mainly seen in patients who received abciximab. CONCLUSIONS: The three closure devices had high rates of successful deployment and were relatively safe. The Angioseal resulted in earlier ambulation after angiography. Utilization of closure devices after abciximab administration possibly increased the complications.