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Aims: Coronary artery disease is often diffuse and patients with non-ST-segment acute coronary synd

Since the fi rst balloon angioplasty was performed in the late 1970’s, percutaneous coronary intervention (PCI) has undergone rapid transformation to become an essential treatment option for coronary artery disease as an alternative to surgery. PCI is now widely accepted across the globe, with over half a million procedures being performed annually in the United States alone. Coronary stents were developed in the mid-1980s, and the fi rst randomized trials comparing stenting to balloon angioplasty demonstrated improved angiographic and clinical outcomes. Consequently, coronary artery stenting has progressively replaced balloon angioplasty as the preferred method of PCI. In these initial trials, acute stent thrombosis was a major concern because of high morbidity and mortality. The introduction of dual-antiplatelet therapy with aspirin and a thienopyridine (such as Clopidogrel) as well as improv

Aims: As the global population ages, elderly patients will form an increasing proportion of those undergoing percutaneous coronary intervention (PCI). We investigated the safety and efficacy of bare metal stents (BMS) and DES in all patients undergoing PCI at our institution, stratified by age. Methods and results: We investigated three sequential groups of consecutive patients treated exclusively with BMS (n=2,194; January 2000 to April 2002), sirolimus-eluting stents (SES, n=834; April 2002 to February 2003) and paclitaxel-eluting stents (PES, n=2,841; February 2003 to December 2005). The primary endpoint was all-cause mortality. Secondary endpoints included target vessel revascularisation (TVR) and composite major adverse cardiac events (MACE, defined as all-cause death, any nonfatal myocardial infarction or TVR). Patients were followed up for a median of 1,366 days. Patients were stratified into equal quintiles based on age (<51.8, 51.8-58.4, 58.4-65.4, 65.4-73.0 and >73.0 years). All-cause mortality was significantly higher in the eldest two groups, while TVR rates were similar across all age groups. DES were associated with reductions in TVR and MACE and a trend towards reduced mortality in all age groups. Conclusions: DES are safe and effective when compared to BMS, irrespective of age.

Aims: To investigate the clinical impact of the following observations in the randomized SPIRIT II and III trials: an incremental increase in in-stent neointima between 1 and 2 years with the everolimus-eluting stent (EES) but not with the paclitaxel-eluting stent (PES) in SPIRIT II; a tendency of lower stent thrombos

Aims: Sirolimus- and paclitaxel- eluting stents (SES and PES respectively) have been shown to produce a sustained reduction in restenosis and repeat revascularisations as compared to bare-metal stents (BMS) up to four years. There is still limited data about the long-term safety and efficacy of DES in high-risk subgroups. Methods and results: A total of 6,129 consecutive patients were treated during three sequential periods with BMS (n=2,428; January, 2000 to April, 2002), SES (n=866; April 2002 to February 2003) or PES (n=2,835; February 2003 to December 2005). A stratified analysis (including age, gender, diabetes, clinical presentation, treated vessel, multivessel disease, AHA lesion class, bifurcation, in-stent restenosis, average stent diameter ≤2.5 mm and total stented length ≤30 mm) was performed

Aims: The objective of the study is to determine the demographics and the in-hospital outcome of diabetic and non-diabetic patients treated with percutaneous coronary interventions (PCI) in Europe, to report the type of equipment and technology used for PCI procedures in diabetics and to clarify whether the treatment of diabetic patients complies with current European Society of Cardiology (ESC) guidelines. Methods and results: A total of 14,458 patients treated with PCI were enrolled from 29 member countries of the ESC between June 2005 and January 2006. Data were collected on patient characteristics and treatment, using new Cardiology Audit and Registration Data standards. In total, 3,603 patients (24.9%) were diabetic. Diabetics were older, more often female and had a higher body mass index than non-diabetics. Diabetics had higher rates of hypercholesterolaemia and hypertension, while current smokers were more frequent in the non-diabetics. Diabetics also had significantly higher rates of previous cardiovascular events. Clopidogrel was administered only in 48.1% of diabetic patients before PCI, while IIb/IIIa inhibitors were 22.9% during PCI. At discharge, there was a major adjustment of treatment with increases in the use of Beta-blocker (80.4%), angiotensin converting enzyme inhibitor (ACEI, 71.3%) and statins (89.8%) compared with on admission (Beta-blocker 60.9%, ACEI 55.0%, statin 63.1%). Inhospital mortality was higher in diabetics (1.8% vs 1.2%) although the in-hospital MACCE rate was not significantly different (3.6% vs 3.0%, p=0.09). Conclusions: Diabetic patients treated with PCI were older with more comorbidity. According to ESC guideline, the under-usage of clopidogrel, GP IIb/IIIa inhibitors should be improved. PCI is now taken as a good opportunity to adjust the use of appropriate medication.

Aims: The main objective was to use IVUS-backscatter radiofrequency (IVUS-RF) to assess the degradation of a bioabsorbable stent by measuring serial changes in dense calcium (DC) and necrotic core (NC) as assessed by intravascular ultrasound-Virtual Histology™ (IVUS-VH) and in the strain as assessed by palpography. Methods and results: In the ABSORB trial, 27 patients treated with a single bioabsorbable everolimuseluting stent (BVS, Abbott Vascular, Santa Clara, CA, USA) were all imaged with IVUS-RF post-s