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AimsThis study assessed changes in left ventricular ejection fraction and regional radial shortening after successful angioplasty of chronic coronary occlusions.MethodsWe studied 95 patients with angina pectoris or exercise-induced ischaemia with a successfully recanalized chronic (median duration 4·3 months) coronary occlusion. Intracoronary stents were implanted in 71%. Left ventriculograms were obtained at baseline and after 6·7±1·4 months. Left ventricular ejection fraction and regional radial shortening were determined by a computer-assisted method.ResultsLeft ventricular ejection fraction increased from 0·62±0·13 at baseline to 0·67±0·11 at follow-up (P<0·001). The change in left ventricular ejection fraction in patients with a patent artery and in patients with reocclusion (n=8) was 0·05±0·06 and 0·01±0·04, respectively (P=0·04). Regional radial shortening in the territory of the recanalized artery increased by 16% (from 0·28±0·11 to 0·32±0·11, P<0·001) in patients with a patent artery at follow-up, but was unchanged in patients with reocclusion.ConclusionLong-term patency after recanalization of old, chronic coronary occlusions in patients with angina pectoris is associated with improvement in global and regional left ventricular function. This may be a result of recovery of hibernating myocardium and supports the strategy of recanalizing chronic coronary occlusions. [ABSTRACT FROM PUBLISHER]

Left ventricular (LV) filling as assessed by Doppler transmitral flow velocity measurements was studied in 20 male patients with coronary artery disease (CAD) and in 18 normal individuals. Stroke volume, blood pressure and heart rate in the two groups were not significantly different. Compared to normals, the ratio between early and atrial-induced peak velocities was significantly lower in the patients (1.2±0.3 vs.1.40±0.3, P =0.01), as was the fraction of transmitral filling during the first ⅓ of diastole (45 ±7% vs.50 ± 4%, P > 0.001). Isovolumic relaxation time (IVR) was 96 ± 13 ms in patients vs. 74±12 ms in normals (P>0-001) The CAD patients were treated with atenolol for 13–24 days. The velocity ratio increased by 30% (P>0001) due to a 12% increase in early (P = 0.004) and an 11% decrease in atrial-induced peak velocities (P = 0.01). Filling fraction and deceleration rate of early inflow both increased by 22% (P > 0001). IVR decreased by 8% (P = 0.01). After atenolol treatment, heart rate and blood pressure decreased by 23% and 10% (P>0001), respectively, whereas stroke volume increased by 14% (P>0001). Thus, CAD was associated with Doppler indices of retarded LV filling and myocardial relaxation. After atenolol treatment, significant increases in velocity ratio and filling fraction indicated a shift of filling from late towards early diastole, suggesting improved diastolic function. However, different factors related to betaadrenergic blockade may have contributed to the observed changes. [ABSTRACT FROM PUBLISHER]

In a randomized multicenter study initial success rate and 6 months' follow-up were compared between coronary angioplasty performed with the Barath Cutting Balloon (group A, n = 32) and conventional balloons (group B, n = 32) in patients with type A or B lesions in native coronary arteries. The culprit lesion was not reached in one patient in group A. Initial success rates were similar with and without additional stenting (8 in group A and 10 in group B). Angiographic follow-up data (in 95%) revealed a non-significant improvement in minimal lumen diameter, diameter stenosis in group A. Restenosis developed in 16.7% of group A vs 25.8% of group B, (p = 0.57). A separate analysis of stented patients showed no restenosis in group A and restenosis in 4 out of 10 patients in group B (p = 0.10). A possible beneficial effect of the Cutting Balloon with respect to in-stent restenosis requires further studies. [ABSTRACT FROM AUTHOR]

Background: Limited data are available on the long-term effects of contemporary drug-eluting stents versus contemporary bare-metal stents on rates of death, myocardial infarction, repeat revascularization, and stent thrombosis and on quality of life.Methods: We randomly assigned 9013 patients who had stable or unstable coronary artery disease to undergo percutaneous coronary intervention (PCI) with the implantation of either contemporary drug-eluting stents or bare-metal stents. In the group receiving drug-eluting stents, 96% of the patients received either everolimus- or zotarolimus-eluting stents. The primary outcome was a composite of death from any cause and nonfatal spontaneous myocardial infarction after a median of 5 years of follow-up. Secondary outcomes included repeat revascularization, stent thrombosis, and quality of life.Results: At 6 years, the rates of the primary outcome were 16.6% in the group receiving drug-eluting stents and 17.1% in the group receiving bare-metal stents (hazard ratio, 0.98; 95% confidence interval [CI], 0.88 to 1.09; P=0.66). There were no significant between-group differences in the components of the primary outcome. The 6-year rates of any repeat revascularization were 16.5% in the group receiving drug-eluting stents and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76; 95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did not differ significantly between the two groups.Conclusions: In patients undergoing PCI, there were no significant differences between those receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction. Rates of repeat revascularization were lower in the group receiving drug-eluting stents. (Funded by the Norwegian Research Council and others; NORSTENT ClinicalTrials.gov number, NCT00811772 .). [ABSTRACT FROM AUTHOR]