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Yao-Jun Zhang,
Bo Xu,
Patrick W Serruys,
Christos V Bourantas,
Javaid Iqbal,
Takashi Muramatsu,
Ming-Hui Li,
Fei Ye, Nai-Liang Tian,
Hector M Garcia-Garcia,
Shao-Liang Chen
International journal of cardiology 05/2013; · 7.08 Impact Factor
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ABSTRACT: The double kissing (DK) crush technique is a modified version of the crush technique. It is specifically designed to increase the success rate of the final kissing balloon post-dilatation, but its efficacy and safety remain unclear.
Data were obtained from the DKCRUSH-I trial, a prospective, randomized, multi-center study to evaluate safety and efficacy. Post-procedural and eight-month follow-up intravascular ultrasound (IVUS) analysis was available in 61 cases. Volumetric analysis using Simpson's method within the Taxus stent, and cross-sectional analysis at the five sites of the main vessel (MV) and three sites of the side branch (SB) were performed. Impact of the bifurcation angle on stent expansion at the carina was also evaluated.
Stent expansion in the SB ostium was significantly less in the classical crush group ((53.81 ± 13.51)%) than in the DK crush group ((72.27 ± 11.46)%) (P = 0.04). For the MV, the incidence of incomplete crush was 41.9% in the DK group and 70.0% in the classical group (P = 0.03). The percentage of neointimal area at the ostium had a tendency to be smaller in the DK group compared with the classical group ((16.4 ± 19.2)% vs. (22.8 ± 27.1)%, P = 0.06). The optimal threshold of post-procedural minimum stent area (MSA) to predict follow-up minimum lumen area (MLA) < 4.0 mm(2) at the SB ostium was 4.55 mm(2), yielding an area under the curve of 0.80 (95% confidence interval: 0.61 to 0.92).
Our data suggest that the DK crush technique is associated with improved quality of the final kissing balloon inflation (FKBI) and had smaller optimal cutoff value of post-procedural MSA at the SB ostium.
Chinese medical journal 04/2013; 126(7):1247-51. · 0.86 Impact Factor
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ABSTRACT: To investigate the effect of low shear stress (LSS) on apoptosis of human vascular endothelial cells (ECs) and explore the possible mechanisms.
Parallel flow chamber was used to apply LSS at 2 dyne/cm(2) on EA.hy926 cells derived from human umbilical vein endothelial cells for 120 min. Cell apoptosis following LSS was verified by morphological observation, DAPI staining and TUNEL test. The level of intracellular reactive oxygen species (ROS) was measured by dihydroethidium (DHE) and mitoSOX. Western blotting was performed to detect the activity of Akt in the cells.
EC detachment and apoptosis were observed after exposure to 2 dyne/cm(2) LSS for 120 min. Time course study showed that the phosphorylation level of Akt on residues Ser473 and Thr308 was elevated after flow initiation. Exposure to LSS at 2 dyne/cm(2) for 120 min resulted in increased ROS production in the ECs at both the mitochondrial and cytoplasmic levels.
Akt activation and increased ROS levels are involved in LSS-induced EC apoptosis.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 03/2013; 33(3):313-7.
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ABSTRACT: Stent grafting for treatment of type B aortic dissection has been extensively used. However, the difference in the long-term clinical outcome between patients with chronic versus acute type B aortic dissection remains unknown. This study aimed to analyze the difference in long-term clinical outcome after endovascular repair for patients with chronic (≥2 weeks) versus acute (<2 weeks) type B aortic dissection.
Between May 2000 and June 2011, a total of 174 patients with type B aortic dissection (56 chronic, 118 acute) treated by endovascular repair were studied prospectively. Follow-up three-dimensional computed tomography scanning and aortoangiography were scheduled at 3-6 months after the index procedure. Propensity score matching was used to compare the difference in the endpoint between the two groups.
The procedure-related event rate was 18.6% in the acute group and 5.4% in the chronic group (P = 0.021), but this difference became nonsignificant after propensity score matching. At the end of follow-up (mean 2.49 years), overall and aorta-related mortality was 11.0% and 7.6%, respectively, in the acute group, and was not significantly different from that in the chronic group (3.6% and 3.6%, P = 0.148 and P = 0.506, respectively). Both false and true lumina showed significant remodeling over time, with >93% complete false-lumen thrombosis. Untreated tear and type I endoleak were predictors of clinical events during follow-up.
Comparable long-term clinical results were achieved in patients with chronic or acute type B aortic dissection after implantation of a stent graft.
Patient Preference and Adherence 01/2013; 7:319-27. · 1.14 Impact Factor
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ABSTRACT: OBJECTIVES: The current study aimed at determining the best cutoff value of angiographic and intravascular ultrasound (IVUS) parameters for defining fractional flow reserve (FFR) <0.8 in patients with single coronary artery lesion. BACKGROUND: The correlation between angiographic or IVUS variables and FFR in patients with single coronary artery lesions has not been studied yet. METHODS: Quantitative coronary analysis and IVUS and FFR measurements were used in 323 patients with a single lesion. The best angiographic and IVUS cutoff values and their predictive value for FFR<0.8 were compared using area under the receiver-operator characteristic curve (AUC). RESULTS: FFR<0.8 was in 54.2%. Minimal lumen area (MLA), plaque burden (PB), lesion length (LL) and lesion at left anterior descending artery (LAD) were four predictors of FFR<0.8. LL had less value in predicting FFR<0.8. The cutoff values of PB and MLA for FFR<0.8 were 72.7% and 2.97mm(2). MLA and PB had similar high diagnostic value for vessel size≥3mm (cutoff values: 3.02mm(2) and 80.7%), proximal LAD lesion (cutoff values: 3.04mm(2) and 76.5%) and unstable angina (2.82mm(2) and 71.9%). Combination of MLA (2.82mm(2)) and PB (80.6%) had increased diagnostic value for distal LAD lesion. Only PB (71%) had higher diagnostic value for diabetic patients. MLA and PB could not predict FFR<0.8 for vessel size<3mm, and non-LAD lesion. CONCLUSION: Best cutoff value of MLA and PB for FFR<0.8 in patients with a single lesion is patient-, vessel size- and lesion location-oriented. PB has strengthened diagnostic accuracy for diabetic patients.
International journal of cardiology 12/2012; · 7.08 Impact Factor
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ABSTRACT: The correlation between angiographic or intravascular ultrasound (IVUS) variables and fractional flow reserve (FFR) in patients with single left anterior descending artery (LAD) lesion has not been studied. The current study aimed at determining the best cutoff value of angiographic and IVUS parameters for defining FFR < 0.80 in patients with LAD lesion.
Quantitative coronary analysis, IVUS and FFR measurements were undergone in 169 patients with single LAD lesion. The best angiographic and IVUS cutoff value and their predictive value for FFR < 0.80 were compared using area under the receiver-operator characteristic curve (AUC) in overall patients or in subgroups stratified by lesion sites.
FFR < 0.80 was found in 99 lesions (58.6%). Minimal lumen area (MLA), and plaque burden (PB) were two predictors of FFR < 0.80. Lesion length had less value in predicting FFR < 0.80. The cutoff value of PB and MLA for FFR < 0.80 was 75.4% and 3.03 mm(2). MLA and PB had similar high diagnostic value for proximal (cutoff value 3.04 mm(2) and 76.5%) and distal LAD lesion (2.82 mm(2) and 80.6%). Combination of MLA (2.82 mm(2)) and PB (80.6%) had increased diagnostic value for distal LAD lesion.
MLA and plaque burden had equivalent diagnostic value for FFR < 0.80 when lesion localized in LAD. The predictive value of combination of MLA and plaque burden for distal LAD lesion was strengthened.
Chinese medical journal 12/2012; 125(23):4249-53. · 0.86 Impact Factor
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ABSTRACT: BACKGROUND: The effects of intravascular ultrasound (IVUS)-guided complex approaches using drug-eluting stents (DES) for coronary bifurcation lesions on clinical outcomes has not yet been studied in detail. OBJECTIVE: Our objective was to analyze the difference in one-year outcomes following two-stent techniques involving implantation of DES for coronary bifurcation lesions between IVUS-guided and angiography-guided groups. METHODS: From May 26, 2007 to March 24, 2010, 628 patients received two-stent techniques (324 in the IVUS-guided group and 304 angiography-guided) and were prospectively studied. We compared major adverse cardiac events (MACE, including cardiac death, stent thrombosis [ST], myocardial infarction [MI] and target lesion/vessel revascularization) at 12-months follow-up, before and after adjusting for propensity score matching. RESULTS: At 12-months after the indexed procedure, patients in the angiography-guided group had significantly increased in-stent restenosis. Compared to the angiography-guided group, the IVUS-guided group had a significantly lower overall unadjusted ST rate (1.2% vs. 6.9%, p<0.001), definite ST (0.6% vs. 5.3%, p<0.001), late ST (0.6% vs. 4.3%, p=0.003), MI (4.6% vs. 8.9%, p=0.038) and cardiac death (0.9% vs. 3.3%, p=0.049). By propensity score matching, 123 paired patients were matched. The late ST at 12-months follow-up was 0% in the IVUS-guided group vs. 4.9% in the angiography-guided group (p=0.029), resulting in significant differences in ST-elevation MI between the two groups (2.4% vs. 9.8%, p=0.030). CONCLUSIONS: The IVUS-guided two-stent technique was associated with significantly reduced late stent thrombosis, with a resultant reduction in ST-elevation MI. © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions 08/2012; · 2.29 Impact Factor
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Fei Ye,
Shao-Liang Chen,
Jun-Jie Zhang,
Zhong-Sheng Zhu,
Jing Kan, Nai-Liang Tian,
Song Lin,
Zhi-Zhong Liu,
Wei You,
Hai-Mei Xu,
Jing Xu
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ABSTRACT: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for bifurcation lesions is still not fully studied. The aim of this study was to analyze the hemodynamic changes in FFR after double kissing (DK) crush and provisional side branch (SB) stenting (PS) for true coronary bifurcation lesions.
Seventy-five patients with true bifurcated lesions were randomly divided into DK (n = 38) and PS (n = 37) groups. Additional SB stenting in the PS group was required if there was any pinched SB ostium > 70% stenosis, or ≥ type B dissection, or TIMI flow < grade 3. FFR at hyperemia in the main vessel (MV) and SB was measured prior- and post-stenting, and at 8 months follow-up.
Baseline clinical, angiographic and lesion characteristics were matched well between the two groups, with the exception of the final kissing balloon inflation (FKBI, 100.0% in the DK vs. 83.8% in the PS group, P < 0.001). Baseline FFR was comparable between the DK and the PS groups, however, the acute gain and late loss of SB FFR at 8-month follow-up in the DK group were 0.18 ± 0.15 and -0.06 ± 0.11, compared to 0.12 ± 0.18 (P = 0.044) and -0.002 ± 0.07 (P = 0.037) in the PS group, respectively. MV FFR post-stenting > 0.94 was seen in about 40% of patients. There was no significant difference in the clinical events at 1-year follow-up between the two groups.
DK crush was associated with improved acute gain and late loss of SB FFR. The lower rate of FFR > 0.94 after stenting underscored the further improvement of stenting quality.
Chinese medical journal 08/2012; 125(15):2658-62. · 0.86 Impact Factor
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ABSTRACT: The definitive treatment for myocardial ischemia is reperfusion. However, reperfusion injury has the potential to cause additional reversible and irreversible damage to the myocardium. One likely candidate for a cardioprotection is adenosine. The present study aimed at investigating the effect of intravenous adenosine on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Patients with STEMI within 12 hours from the onset of symptoms were randomized by 1:1:1 ratio to receive either adenosine 50 µg×kg(-1)×min(-1) (low-dose group, n = 31), or 70 µg×kg(-1)×min(-1) (high-dose group, n = 32), or saline 1 ml/min (control group, n = 27) for three hours. Drugs were given to the patients immediately after the guide wire crossed the culprit lesion. Recurrence of no-reflow, TIMI flow grade (TFG) and TIMI myocardial perfusion grade (TMPG), and collateral circulation were recorded. The postoperative and preoperative ST segment elevation sum of 18-lead electrocardiogram (ECG) and their ratio (STsum-post/STsum-pre) were recorded, as well as the peak time and peak value of CK-MB enzyme. Serial cardiac echo and myocardial perfusion imaging were performed at 24 hours and 6 months post-stenting. The primary endpoint was left ventricular function, and infarct size. The secondary end-point was the occurrence of cardiac and non-cardiac death, non-fatal myocardial infarction, and heart failure.
A total of 90 STEMI patients were studied. No-reflow immediately after stent procedure was seen in 11 (35.5%) patients in the control group, significantly different from 6.3% in the low-dose group or 3.7% in the high-dose group (both P = 0.001). STsum-post/STsum-pre in the low-dose and high-dose groups was significantly different from the control group (low-dose group vs. control group, P = 0.003 and high-dose group vs. control group, P = 0.001), without a dose-dependent pattern (P = 0.238). The peak value of CK-MB enzyme was significantly reduced in the high-dose group compared to the control group (P = 0.024). Compared to the left ventricular ejection fraction (LVEF) in control group, LVEF in the low-dose group increased by 5.8% at 24 hours (P = 0.012) and by 10.9% at 6 months (P = 0.007), LVEF in the high-dose group increased by 9.5% at 24 hours (P = 0.001) and by 10.0% at 6 months (P = 0.001), respectively. Significant reduction of infarct size by 24.2% was detected in the high-dose group vs. low-dose or control groups (P = 0.008). There was no significant difference regarding secondary endpoints at 6 months among the treated groups. Cardiac function by NYHA classification in both the low-dose and the high-dose groups was improved significantly (P = 0.013, P = 0.016).
Intravenous adenosine administration might significantly reduce the recurrence of no-reflow, with resultant improved left ventricular systolic function. High-dose adenosine was further associated with significant reduction of infarct size.
Chinese medical journal 05/2012; 125(10):1713-9. · 0.86 Impact Factor
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ABSTRACT: Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion (CTO) vessel after successful recanalization remain to be unknown.
Between January 2001 and December 2009, 195 (41.1%) patients with 254 (47.0%) bifurcation lesions in CTO vessels from a pool of 564 patients with 659 CTO lesions were included and divided into proximal (n = 134) and distal (n = 120) groups, according to the location of the bifurcation lesions. The primary endpoint was the occurrence of major adverse cardiac events (MACE) at the end of clinical follow-up, including cardiac death, myocardial infarction, or target vessel revascularization (TVR).
Collaterals with Rentrop class 3 were seen more in distal group (100% and 68.3%), compared to proximal group (76.9% and 45.6%). Two-stent technique for proximal bifurcation lesions was used in 24.6%, significantly different from the distal group (6.7%, P < 0.001), without significant difference in composite MACE between proximal and distal groups, or between one- and two-stent subgroups in proximal group. The composite MACE after 1-year in complete revascularization subgroup was 17.9% relative to 29.6% in the incomplete revascularization group (P = 0.044). Stents in long false lumen in main vessel were mainly attributive to decreased TIMI grade flow, with resultant increased in-stent restenosis, total occlusion, TVR and coronary aneurysms. Imcomplete revasculzarization (HR 2.028, P = 0.049, 95%CI 1.002 - 4.105) and post-stenting TIMI flow (HR 6.122, P = 0.020, 95%CI 1.334 - 28.092) were two independent predictors of composite MACE at the 1-year follow-up.
Two-stent was more used for proximal bifurcation lesions. No significant difference was observed in MACE between proximal and distal, or between one- and two-stent subgroups in the proximal group. Placement of a safety wire was critical for proximal bifurcation lesions. Complete revascularization was mandatory to improve clinical outcomes.
Chinese medical journal 03/2012; 125(6):1035-40. · 0.86 Impact Factor
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ABSTRACT: The gender-based differences in adverse events after drug-eluting stent (DES) implantation between Chinese women and men have not been fully studied. The present study aimed to compare the 5-year clinical outcome after DES implantation in Chinese women and men.
Chinese women (n = 298) and men (n = 698) with newly diagnosed de novo coronary lesions were studied after DES implantation. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) over a 5-year follow-up, including myocardial infarction (MI), cardiac death, and target vessel revascularization (TVR). Propensity score matching (PSM) was used to compare the adjusted MACE rates between sexes.
Women differed in body habitus and had increased fasting cholesterol. Fewer women presented with MI, and they had better cardiac function with less complex disease. The unadjusted rate of MI at 3 years (2.1%) and 5 years (5.0%) and MACE (25.2%) at 5 years in men was significantly higher than that of women (0.3%, 1.0% and 17.8%, P = 0.050, P = 0.032, and P = 0.011, respectively). After PSM, the adjusted adverse events between sexes were similar. The stent thrombosis rate rapidly increased after 2 years in men.
There were significant gender-based differences in baseline characteristics. Chinese men had equivalent outcomes to women after DES after adjustment by PSM. The increased rate of MI in men was attributed to an increased unadjusted rate of MACE.
Chinese medical journal 01/2012; 125(1):7-11. · 0.86 Impact Factor
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ABSTRACT: This study aimed to compare the neointimal coverage (NIC), subclinical thrombus, color of plaque underneath the stent at 9-month after implantation of sirolimus-eluting stent (SES) either with durable or with biodegradable polymer (BDPM).
A total of 175 patients were assigned as Cypher (n = 81, 97 stents with durable polymer) and Excel (n = 94, 112 stents with BDPM) stent at 9-month after indexed procedure. NIC was classified from grade 0-3. Color of plaque was divided into white, light-yellow, yellow, and dark yellow. Thrombus was diagnosed as white or red material with cotton-like or ragged appearance. Incomplete NIC (grade 0/1) circled by a blush was termed by "inflaming."
There were significant differences in unstable angina (90.5 vs. 52.4%, P = 0.015), previous myocardial infarction (33.3 vs. 4.0%, P = 0.045) and left ventricular eject fraction (55.2 ± 7.8 vs. 62.6 ± 6.3%, P = 0.021) between the Excel and Cypher groups. The minimal- and maximal-NIC grades in the Cypher group were 0.67 ± 0.58 and 2.29 ± 0.46, respectively, when compared with 1.45 ± 0.67 (P < 0.001) and 2.64 ± 0.49 (P = 0.023) in the Excel group. The percentage of yellow plaque, thrombus, "inflaming" and NIC grade of 0 in the Excel and Cypher groups, respectively, were as follows: 8.0 vs. 26.8% (P = 0.031), 9.8 vs. 32.9% (P = 0.024), 8.0 vs. 38.1% (P = 0.017), and 38.1 vs. 0% (P < 0.001). Of the stents with "inflaming," 63.6% had thrombus when compared with 20.1% of the non-erosion stents (P < 0.001). Overlapping segments had the lowest NIC grades and more "inflaming" demonstrating a significant difference between Cypher vs. Excel stents. NIC grade was positively correlated with thrombus.
SES with BDPM has improved NIC resulting in less yellow plaque, thrombus, and "inflaming." Overlapping segments had the lowest NIC grade and more "inflaming."
Catheterization and Cardiovascular Interventions 09/2011; 80(3):420-8. · 2.29 Impact Factor
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ABSTRACT: Compared with the classical crush, double kissing (DK) crush improved outcomes in patients with coronary bifurcation lesions. However, there is no serial intravascular ultrasound (IVUS) comparisons between these two techniques.
This study aimed to analyze the mechanisms of the two crush stenting techniques using serial IVUS imaging.
A total of 54 patients with IVUS images at baseline, post-stenting and eight-month follow-up were classified into classical (n = 16) and DK (n = 38) groups. All patients underwent final kissing balloon inflation (FKBI). Unsatisfactory kissing (KUS) was defined as the presence of wrist or >20% stenosis during FKBI at the side branch (SB) ostium. The vessels at bifurcation lesions were divided into the proximal main vessel (MV) stent, the crushed segment, the distal MV stent, the SB ostium and the SB stent body.
KUS and incomplete crushing were commonly observed in the classical group (62.5%, 81.3%), compared with DK group (18.0%, 39.5%, P < 0.001 and P = 0.004). The post-stenting stent symmetry in the classical group was 71.85 ± 7.69% relative to 85.93 ± 6.09% in DK group (P = 0.022), resulting in significant differences in neointimal hyperplasia (NIH, 1.60 ± 0.21 mm(2) vs. 0.85 ± 0.23 mm(2) , P = 0.005), late lumen loss (1.31 ± 0.81 mm(2) vs. 0.55 ± 0.70 mm(2) , P = 0.013), and minimal lumen area (MLA, 3.57 ± 1.52 mm(2) vs. 4.52 ± 1.40 mm(2,) P = 0.042) at the SB ostium between two groups. KUS was positively correlated with the incomplete crush and was the only predictor of in-stent-restenosis (ISR) at the SB ostium.
DK crush was associated with improved quality of the FKBI and larger MLA. KUS predicted the occurrence of ISR.
Catheterization and Cardiovascular Interventions 04/2011; 78(5):729-36. · 2.29 Impact Factor
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Shao-Liang Chen,
Jun-jie Zhang,
Fei Ye,
Zhi-zhong Liu,
Zhong-sheng Zhu,
Song Lin, Nai-liang Tian,
Wei-yi Fang,
Yun-dai Chen,
Xue-wen Sun,
Meng Wei,
Shou-jie Shan,
Jing Kan,
Jun Qian,
Song Yang,
Zeng-bai Yuan,
Tak W Kwan,
Da-Yi Hu
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ABSTRACT: Data on the relevance of the location of coronary bifurcation lesions treated by crush stenting with outcomes were limited.
We hypothesized that the location of the bifurcation lesion correlated with clinical outcome.
A total of 212 patients with 230 true bifurcation lesions treated by crush stenting with drug-eluting stents (DES) were assessed prospectively. Surveillance quantitative angiographies were indexed at 8 months after procedure. Primary endpoint was major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, and target lesion revascularization (TLR).
Patients in the distal right coronary artery (RCAd) group were characterized by higher proportions of prior myocardial infarction and very tortuous lesions. However, lesions in the RCAd group, compared to those of other groups, had the lowest late lumen loss, with resultant lowest incidence of MACE at a mean follow-up of 268±35 days. Independent predictors of MACE included unsatisfied kissing (KUS; hazard ratio [HR]: 12.14, 95% confidence interval [CI]: 4.01-12.10, P = .001) and non-RCA lesion (HR: 20.69, 95% CI: 5.05-22.38, P = .001), while those of TLR were KUS (HR: 10.21, 95% CI: 0.01-0.34, P = .002), bifurcation angle (HR: 4.728, 95% CI: 2.541-4.109, P = .001), and non-RCA lesion (HR: 16.05, 95%CI: 1.01-4.83, P = .001).
Classical crush stenting with drug-eluting stents is associated with significantly better outcomes in RCAd. Quality of kissing inflation is mandatory to improve outcome.
Clinical Cardiology 12/2010; 33(12):E32-9. · 2.15 Impact Factor
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ABSTRACT: There were insufficient data on the prognosis of stenting for patients with trifurcated unprotected left main lesions (UPLMS).
From the SPEED (stents for percutaneous treatment of coronary artery disease) registry of all percutaneous coronary interventions (PCI) for all types of UPLMS, data of 44 patients with trifurcated UPLMS were selected and analyzed.
Patients were divided into one-stent (N = 23) or 2-stent (N = 21) groups. Clinical follow-up was available for 100%, and angiographic follow-up at 8 month was available for 91.3%. There were no differences in myocardial infarction, cardiac death, and stent thrombosis between groups. However, the target lesion revascularization (TLR) and target vessel revascularization (TVR) in the 1-stent group was lower when compared to the 2-stent group (13.0% vs. 23.8%, P = 0.004; 13.0% vs. 28.6%, P = 0.003, respectively). Cumulative survival free from major adverse cardiovascular events (MACE) in the 1-stent group was higher than the 2-stent group (65.2% vs. 57.1%, P = 0.033). Analysis of the receiver operator curve (ROC) of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score showed the area under the curve was 0.414 (standard error = 0.089, 95% CI 0.240-0.589, P = 0.348).
In patients with trifurcated UPLMS, higher TLR/TVR and lower cumulative survival from MACE were seen in the 2-stent group when compared to the 1-stent group. The SYNTAX scoring system had no predictive value of outcomes for patients with stenting of trifurcated UPLMS.
Journal of Interventional Cardiology 08/2010; 23(4):352-7. · 1.18 Impact Factor
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ABSTRACT: While many studies confirmed the importance of fractional flow reserve (FFR) in guiding complex percutaneous coronary interventions (PCI), data regarding the significance of FFR for bifurcation lesions are still lacking.
Between October 2008 and October 2009, 51 patients with true bifurcation lesions were consecutively enrolled and randomized into double kissing (DK) crush (n = 25), and provisional 1-stent (n = 26) groups. FFR measurements at baseline and hyperemia were measured at pre-PCI, post-PCI, and at 8-month follow-up.
Clinical follow-ups were available in 100% of patients while only 33% of patients underwent angiographic follow-up. Baseline clinical and angiographic characteristics were matched between the 2 groups. Pre-PCI FFR of the main branch (MB) in the DK group was 0.76 +/- 0.15, which was significantly lower than in the provisional 1-stent group (0.83 +/- 0.10, P = 0.029). This difference disappeared after the PCI procedure (0.92 +/- 0.04 vs. 0.92 +/- 0.05, P = 0.58). There were no significant differences in terms of baseline, angiographic, procedural indexes, and FFR of side branch (SB) between the 2 treatment arms. However, immediately after PCI, the patient with DK crush had higher FFR in the SB as compared to the provisional 1-stent group (0.94 +/- 0.03 vs. 0.90 +/- 0.08, P = 0.028, respectively) and also they had lower diameter stenosis (8.59 +/- 6.41% vs. 15.62 +/- 11.69%, P = 0.015, respectively).
In the acute phase, immediately after PCI for bifurcation lesion, DK crush stenting was associated with higher FFR and lower residual diameter stenosis in the SB, as compared with the provisional 1-stent group.
Journal of Interventional Cardiology 08/2010; 23(4):341-5. · 1.18 Impact Factor
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ABSTRACT: Background: While many studies confirmed the importance of fractional flow reserve (FFR) in guiding complex percutaneous coronary interventions (PCI), data regarding the significance of FFR for bifurcation lesions are still lacking.Methods: Between October 2008 and October 2009, 51 patients with true bifurcation lesions were consecutively enrolled and randomized into double kissing (DK) crush (n = 25), and provisional 1-stent (n = 26) groups. FFR measurements at baseline and hyperemia were measured at pre-PCI, post-PCI, and at 8-month follow-up.Results: Clinical follow-ups were available in 100% of patients while only 33% of patients underwent angiographic follow-up. Baseline clinical and angiographic characteristics were matched between the 2 groups. Pre-PCI FFR of the main branch (MB) in the DK group was 0.76 ± 0.15, which was significantly lower than in the provisional 1-stent group (0.83 ± 0.10, P = 0.029). This difference disappeared after the PCI procedure (0.92 ± 0.04 vs. 0.92 ± 0.05, P = 0.58). There were no significant differences in terms of baseline, angiographic, procedural indexes, and FFR of side branch (SB) between the 2 treatment arms. However, immediately after PCI, the patient with DK crush had higher FFR in the SB as compared to the provisional 1-stent group (0.94 ± 0.03 vs. 0.90 ± 0.08, P = 0.028, respectively) and also they had lower diameter stenosis (8.59 ± 6.41% vs. 15.62 ± 11.69%, P = 0.015, respectively).Conclusion: In the acute phase, immediately after PCI for bifurcation lesion, DK crush stenting was associated with higher FFR and lower residual diameter stenosis in the SB, as compared with the provisional 1-stent group. (J Interven Cardiol 2010;23:341–345)
Journal of Interventional Cardiology 07/2010; 23(4):341 - 345. · 1.18 Impact Factor
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Shao-liang Chen,
Fei Ye,
Jun-jie Zhang,
Song Lin,
Zhong-sheng Zhu, Nai-liang Tian,
Zhi-zhong Liu,
Xue-wen Sun,
Ai-ping Zhang,
Feng Chen,
Shi-qin Ding,
Jack Chen
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ABSTRACT: The safety of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting (CABG) support was available.
A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction and target-vessel revascularization (TVR).
The incidence of CTO was 7.9% in patients who underwent PCI. Successful recanalization was achieved in 132 patients (86.8%). Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths ((42.32 +/- 22.08) mm vs (27.61 +/- 22.85) mm, P = 0.023), a higher rate of perforation (25.0% vs 0, P = 0.014), and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure (10.0%, 30.0% and 35.0%) and the success (3.0%, 12.1% and 14.4%) groups (P = 0.037, 0.034 and 0.040, respectively). These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group (P = 0.031 and 0.023, respectively). Stump was the only predictor of recanalization success (HR 0.158, 95% CI 0.041-0.612, P = 0.008), whereas procedural failure (OR 13.023, 95% CI 6.67-13.69, P = 0.002), incomplete revascularization (OR 9.71, 95% CI 2.93-5.59, P = 0.005), and total stent length (OR 6.02, 95% CI 1.55-11.93, P = 0.027) were three independent predictors of MACE.
PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.
Chinese medical journal 10/2009; 122(19):2278-85. · 0.86 Impact Factor
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Chinese medical journal 04/2009; 122(6):736-40. · 0.86 Impact Factor
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Shao-liang Chen,
Jun-jie Zhang,
Fei Ye,
Yun-dai Chen,
Wei-yi Fang,
Meng Wei,
Ben He,
Xue-wen Sun,
Song Yang,
Jin-guo Chen,
Shou-jie Shan, Nai-liang Tian,
Xiao-bo Li,
Zhi-zhong Liu,
Jing Kan,
Lee Michael,
Kwan-tak W
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ABSTRACT: Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high (> or = 60 degrees ) with low (< 60 degrees ) bifurcation angle in patients who underwent either classical or double kissing (DK) crush stenting for bifurcation lesions from the DKCRUSH-1 data base.
There were 212 patients with 220 lesions, some with low-angle (n = 138) and some with high-angle (n = 74). Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events (MACEs), defined as cardiac death, myocardial infarction and target lesion revascularization (TLR). Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation (FKBI).
At 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group (91.43%) and the low-angle group (82.39%). In the high angle group, there was a significant difference in contrast volume used (P = 0.005) but no significant difference in acute gain, minimum lumen diameter (MLD), late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with-(n = 133) and without-FKBI (n = 42), significant side-branch late loss was seen in the group without-FKBI ((0.65 +/- 0.49) mm vs (0.47 +/- 0.62) mm, P = 0.02), with a resultant greater restenosis rate (37.68% vs 18.32%, P = 0.001). No difference was detected in the MACE free survival rate between the high and low angle groups (82.39% vs 82.36%, P = 0.84). The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference (P = 0.38). The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group (P = 0.001). Cox regression analysis showed that the independent predictors for target vessel revascularization were the side branch stent MLD post stenting (hazard ratios (HR) 1.028, 95% CI 2.357 - 16.233, P = 0.002), lack of FKBI (HR 4.910, 95% CI 4.706 - 8.459, P = 0.001) and unsatisfactory kissing (HR 3.120, 95% CI 2.975 - 5.431, P = 0.001).
Bifurcation angles do not influence the clinical outcome of crush stenting. Successful final kissing balloon inflation, regardless of bifurcation angles, can predict TLR.
Chinese medical journal 02/2009; 122(4):396-402. · 0.86 Impact Factor
