Deteriorative effect of smoking on target lesion revascularization after implantation of coronary stents with diameter of 3.0 mm or less.
ABSTRACT Although smoking cessation is widely encouraged because of the associated risk of cardiovascular events, the impact of smoking on target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) is controversial. Therefore, the present study retrospectively investigated the effect of smoking on TLR after plain-old balloon angioplasty (POBA; n=376) and stenting (STENT; n=434) in patients undergoing secondary coronary angiography at a single center.
A smoker was defined as current smoking or quitting within 2 years of the first PCI. In the POBA group, the predictors for TLR, as calculated by multiple logistic regression analysis, were a complex type of lesion (p<0.0001) and the left anterior descending artery (LAD) as affected vessel (p<0.05). In the STENT group, the predictors were the final % diameter of stenosis after stenting, measured by quantitative coronary arteriography (p<0.0005), LAD (p<0.01), and smoking (p=0.049). When the STENT group was divided into 2 groups according to the diameter of the implanted stent, smoking was a predictive factors for TLR in the group that received relatively small stents (diameter < or =3.0 mm) (p<0.02), but not in the group that received larger stents (diameter > or =3.5 mm).
Smoking has a deteriorative effect on TLR after implantation of relatively small coronary stents with a diameter of 3.0 mm or less.
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ABSTRACT: We estimated the benefit of a sirolimus-eluting stent (SES, Cypher) for diffuse (> 10 mm) in-stent restenosis (ISR) inside bare metal stents (BMS) because the feasibility of the SES was not confirmed after its recent approval in Japan. Clinical and angiographic outcomes after SES implantation to 93 diffuse ISR were compared with those of 3 groups treated by plain old balloon angioplasty (POBA, (n = 54)), cutting balloon angioplasty (CB, (n = 24)), and BMS (n = 41) in a series of 153 patients whose follow-up quantitative coronary angiography (QCA) evaluated 3-9 months after the treatments was obtained from January 2003 through December 2005. For 33 lesions in the SES group, 12-month follow-up QCA results were obtained and compared with those at 6 months. Ticlopidine (200 mg/day) was prescribed for at least 12 weeks after SES implantation and for 2 weeks after BMS in addition to aspirin (81-100 mg/day). Patient characteristics and the characteristics of previous implanted BMS in the SES group were not significantly different from those in the other groups. Death from cardiac causes and nonfatal myocardial infarction did not occur in any group. Stent thrombosis was not observed in the BMS and SES groups. The incidence of repeat target lesion revascularization (re-TLR) in the SES group (3.23%) was significantly lower compared with that of the POBA (37.0%), CB (25.0%), and BMS (29.3%) groups (P < 0.001, respectively). Late loss in the SES group (0.44 +/- 0.41 mm) was significantly smaller than that in the BMS group (1.34 +/- 0.74 mm) (P < 0.05). The rate of recurrent ISR (re-ISR) in SES (5.38%) was significantly lower than that in POBA (46.3%), CB (41.7%), and BMS (46.3%) (P < 0.001, respectively). The QCA variables at 6 months in the SES group were not significantly different from those at 12 months. Thus, SES implantation for diffuse ISR was far superior since it markedly reduced the incidence of re-TLR with re-ISR at up to 6-months follow-up. In addition, this angiographic patency after SES implantation continued until 12 months.International Heart Journal 09/2006; 47(5):651-61. DOI:10.1536/ihj.47.651 · 1.13 Impact Factor
- Circulation Journal 01/2007; 71(3):418-422. DOI:10.1253/circj.71.418 · 3.69 Impact Factor
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ABSTRACT: Although cigarette smoking is thought to constrict peripheral vessels, details have not been clarified because of the limitation of spatial resolution in conventional X-ray angiography systems. Synchrotron radiation microangiography can identify small arteries down to 50 microm in diameter. Male Wistar rats (n=9) were made to smoke a cigarette using the modified Griffith snout exposure system. Angiography of the rat hind limb was performed before, during, and 15 min after smoking. Arteries were classified into 3 groups based on the pre-smoking diameter: Group S: <100 microm, Group M 100-200 microm, Group L: >200 microm). In Groups M and L, arteries were constricted with smoking (mean diameter 140-106 microm; p<0.001, 260-162 microm; p<0.00001, respectively), whereas no constriction was noted in Group S (82-83 microm). Constricted arteries in Groups M and L returned to pre-smoking levels at 15 min after cessation of smoking. The acute changes brought about by cigarette smoking in rat peripheral arteries could be identified by synchrotron radiation microangiography. Cigarette smoking exclusively constricted arteries greater than 100 mum in diameter, which means there is vessel-size dependency of the impairment.Circulation Journal 03/2007; 71(3):418-22. · 3.69 Impact Factor