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Biomedical subjects

Carlos Macaya

Publications and source records attributed to Carlos Macaya.

At least 55 records · Page 3Linked to original sources
PubMed2005

Lack of association between the P2Y12 receptor gene polymorphism and platelet response to clopidogrel in patients with coronary artery disease.

INTRODUCTION: Clopidogrel inhibits the ADP subtype P2Y(12) receptor. Recently, polymorphisms of this receptor have been associated with different degrees of platelet aggregation in healthy volunteers and have been suggested to modulate clopidogrel response. However, the role of gene sequence variations of the P2Y(12) receptor in patients treated with clopidogrel has not yet been assessed. MATERIALS AND METHODS: The T744C polymorphism of the P2Y(12) receptor gene was assessed in 119 patients: 36 undergoing coronary stenting receiving a 300 mg loading dose (Group A) and 83 on long-term clopidogrel (75 mg/day) treatment (Group B). Patients were divided into 2 subgroups according to the presence or absence of the C allele: carriers (CT heterozygotes and CC homozygotes) and non-carriers (TT homozygotes). Platelet aggregation, assessed by light transmittance aggregometry following ADP, collagen, TRAP and epinephrine stimuli, and platelet activation (GP IIb/IIIa activation and P-selectin expression), assessed by whole blood flow cytometry in ADP and TRAP-stimulated platelets, were performed. Platelet function was assessed at baseline and 4 and 24 h following clopidogrel loading dose in Group A and when patients where on clopidogrel treatment for at least 1 month in Group B. RESULTS: The genotype distribution of Group A was: 22/36 (61.1%) non-carriers and 14/36 (38.9%) carriers of the C allele; Group B: 57/83 (68.7%) non-carriers and 26/83 (31.3%) carriers of the C allele. There were no differences between groups for all the assessed platelet function assays. CONCLUSIONS: The T744C polymorphism of the P2Y(12) receptor gene does not modulate platelet response to clopidogrel either in the early or long-term phases of treatment. This specific gene polymorphism alone is therefore unlikely to be the cause of variability in individual response to antiplatelet therapy.

Aged↗
PubMed2005

Comparison of left ventricular volumes and ejection fractions measured by three-dimensional echocardiography versus by two-dimensional echocardiography and cardiac magnetic resonance in patients with various cardiomyopathies.

End-diastolic volume and end-systolic volume were measured in 35 consecutive patients with cardiomyopathy using 2-dimensional (2-D) and 3-dimensional (3-D) echocardiography (2, 4, and 8 planes) and cardiac magnetic resonance imaging. Three-dimensional echocardiography correlates better with magnetic resonance imaging than does 2-D echocardiography. Its accuracy improves with the increase in the number of planes used. Two-dimensional echocardiography underestimates volumes, mainly in the subgroup with an ejection fraction of <50%, whereas 3-D echocardiography does not, if enough planes are used. However, in patients with an end-diastolic volume > or =150 ml, the underestimation of 3-D echocardiography is statistically significant. Increasing the number of planes to 8 reduces this bias. Conversely, patients with an end-diastolic volume <150 ml are accurately studied with just 4 planes.

Adult↗
PubMed2005

Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies.

OBJECTIVES: We compared the risk of stent thrombosis (ST) after drug-eluting stents (DES) versus bare-metal stents (BMS), and tested the hypothesis that the risk of DES thrombosis is related to stent length. BACKGROUND: Whether DES increase the risk of ST remains unclear. Given the very low restenosis rate after drug-eluting stenting, longer stents are frequently implanted for the same lesion length in comparison to BMS. METHODS: We included in a meta-analysis 10 randomized studies comparing DES and BMS. Overall, 5,030 patients were included (2,602 were allocated to DES and 2,428 to BMS). The risk of thrombosis after DES versus BMS was compared, and the relationship between the rate of DES thrombosis and stent length was evaluated. RESULTS: Incidence of ST was not increased in patients receiving DES (0.58% vs. 0.54% for BMS; odds ratio: 1.05; 95% confidence interval [CI]: 0.51 to 2.15; p = 1.000). The overall rate of ST did not differ significantly between patients receiving sirolimus- or paclitaxel-eluting stents (0.57% vs. 0.58%; p = 1.000). We found a significant relation between the rate of ST and the stented length (Y = -1.455 + 0.121 X; 95% CI for beta: 0.014 to 0.227; R = 0.716; p = 0.031). In patients with DES, mean stented length was longer in those suffering ST (23.4 +/- 8.1 mm vs. 21.3 +/- 4.1 mm, p = 0.025). CONCLUSIONS: Drug-eluting stents do not increase the risk of ST, at least under appropriate anti-platelet therapy. The risk of ST after DES implantation is related to stent length.

Antibiotics, Antineoplastic↗
PubMed2005

Endothelial hypoxic preconditioning in rat hypoxic isolated aortic segments.

Our aim was to analyse endothelial hypoxic preconditioning after hypoxia-reperfusion (HR). Endothelial functionality was analysed through the vasorelaxation responses to acetylcholine (Ach) and the level of serine1177 phosphorylated endothelial nitric oxide synthase (eNOS) (ser1177-eNOS) measured by Western blot in in vitro hypoxic preconditioned (P + HR) isolated rat aortic segments. Relaxation in response to Ach was reduced in phenylephrine-precontracted aortic segments after HR (control: IC50, 5 +/- 2.5 x 10(-8) mol l(-1); HR: IC50, 3 +/- 1.2 x 10(-7) mol l(-1); P < 0.05). Ach-dependent vasodilatation was improved by P + HR. The content of ser1177-eNOS in the HR segments was 1.5-fold lower than in P + HR. Confocal microscopy showed an increased content of both superoxide anion and peroxynitrite in the vascular wall of HR aortic segments, which it was reduced by P + HR. Geldanamycin (10 microg ml(-1)), an agent known to inhibit heat shock protein 90 (hsp90), reduced the level of ser1177-eNOS in P + HR aortic segments. However in the presence of geldanamycin, endothelial hypoxic preconditioning persisted. We conclude that short periods of hypoxia induced endothelial hypoxic preconditioning that was accompanied by enhanced levels of ser1177-eNOS in the vascular wall. The fact that endothelial hypoxic preconditioning persisted in the presence of geldanamycin suggests that other molecular mechanisms are involved in the endothelial adaptation to HR injury.

Acetylcholine↗
PubMed2005

Implications of the "watermelon seeding" phenomenon during coronary interventions for in-stent restenosis.

The occurrence of balloon slippage ("watermelon seeding"; WMS) during treatment of patients with in-stent restenosis (ISR) has been described, but predisposing factors and the potential implications of this phenomenon remain unknown. In the Restenosis Intrastent: Balloon Angioplasty vs. Elective Stenting (RIBS) randomized study, 450 patients with ISR were included. Of these, 42 patients (9%) presented WMS during the procedure. WMS was detected in 26 patients (12%) in the balloon arm and 16 (7%) in the stent arm (P=0.11). In the stent arm, WMS was only noticed during balloon predilation, never during stent implantation. As compared with 408 patients without WMS, patients with WMS had more severe (TIMI flow 1; 21% vs. 8%; P=0.01) and diffuse (length>15 mm: 45% vs. 28%; P=0.02) ISR lesions. Patients with WMS required more balloon inflations, longer total inflation time, had more frequent crossover to stenting or ended the procedure with residual dissections, and eventually obtained poorer acute results (minimal lumen diameter, 2.35+/-0.5 vs. 2.53+/-0.5 mm; P=0.03). In addition, at 6-month follow-up, patients with WMS had a smaller minimal lumen diameter (1.26+/-0.7 vs. 1.61+/-0.7 mm; P=0.007) and a higher restenosis rate (56% vs. 37%; P=0.017). On logistic regression analysis, the WMS phenomenon emerged as an independent predictor of recurrent restenosis (adjusted RR=2.1; 95% CI=1.1-4.1; P=0.04). The WMS phenomenon may complicate treatment of patients with ISR. Long and severe lesions appear to predispose to this technical problem that never occurs during stent deployment. In patients with ISR, WMS is associated with cumbersome procedures and poorer acute and long-term angiographic results.

Angioplasty, Balloon, Coronary↗
PubMed2005

Repeat stenting for the prevention of the early lumen loss phenomenon in patients with in-stent restenosis. Angiographic and intravascular ultrasound findings of a randomized study.

BACKGROUND: Early lumen loss (ELL) may be detected in patients undergoing coronary interventions for in-stent restenosis. This phenomenon may contribute to recurrences. This prospective, randomized study was designed to determine if repeat stent implantation may prevent ELL in patients with in-stent restenosis. METHODS: Forty patients were randomized: 20 were allocated to elective stent implantation and 20 to conventional balloon angioplasty. Quantitative coronary angiography and intravascular ultrasound (IVUS) volumetric studies were systematically performed (1) before the procedure, (2) immediately after intervention, and (3) 30 to 60 minutes later. RESULTS: Baseline characteristics were similar in both groups. After the delay time interval (46 +/- 8 minutes), quantitative coronary angiography revealed a significant reduction in minimal lumen diameter (2.2 +/- 0.5 mm vs 1.7 +/- 0.5 mm, P < .001) in the balloon angioplasty arm. Likewise, in this group, IVUS demonstrated a reduction in mean lumen area (7.1 +/- 2 mm2 vs 6.2 +/- 2 mm2 , P < .001) and lumen volume (144 +/- 59 mm3 vs 126 +/- 54 mm3 , P < .001). In 4 of these patients, ELL was severe enough to require further intervention. In the stent arm, however, angiographic data and IVUS mean lumen area (7.7 +/- 3 mm2 vs 7.7 +/- 3 mm2) and lumen volume (161 +/- 72 mm3 vs 160 +/- 69 mm3) remained unchanged after the delay time interval. On multivariate analysis, stent implantation was an independent predictor of the absence of ELL by quantitative coronary angiography and by IVUS. In addition, patients with a larger ELL on IVUS had a lower event-free survival at 1 year (40% vs 79%, log rank P = .003). CONCLUSIONS: This randomized study demonstrates that (1) ELL is frequently detected after treatment of in-stent restenosis with balloon angioplasty, that (2) ELL influences the long-term clinical outcome of these patients, and that (3) repeat stent implantation prevents ELL.

Aged↗
PubMed2005

Long-term prognostic importance of transient left ventricular dilation during pharmacologic stress echocardiography.

OBJECTIVES: We sought to evaluate the prognostic significance of left ventricular (LV) transient ischemic dilation (TID) for patients with a positive stress echocardiogram (SE). BACKGROUND: TID during SE has been related to the presence of extensive coronary artery disease, but its long-term prognostic implications have not been reported. METHODS: In all, 99 consecutive patients with a positive SE comprised the study group. LV volumes were evaluated according to the modified Simpson's rule. TID during SE was defined as the presence of an increase in LV end-diastolic volume during the stress test. A clinical history was fulfilled for each patient and all of them were followed up. RESULTS: Of 99 patients, 32 (32.3%) showed TID. Mean age was 65.8 +/- 9.8 years for non-TID group and 70.2 +/- 8.4 for TID group (P = .048). Baseline characteristics and subsequent treatment were similar in both groups. Mean follow-up was 21.4 +/- 15.8 months. In non-TID group the mean survival free of acute myocardial infarction was 47.28 months and 39.7 months in TID group (log rank = 0.012). In the univariate and multivariate analysis only TID and the wall motion score index were found as independent predictors related to long-term prognosis (risk ratio = 6.9; 95% confidence interval = 0.8-59.6; P = .042; and risk ratio = 0.4; 95% confidence interval = 0.18-0.89; P = .047, respectively). CONCLUSIONS: LV TID during SE is an easy and independent prognostic marker. It helps to select patients with increased risk.

Aged↗
PubMed2005

Distinguishing between ischemic and non-ischemic dilated cardiomyopathy based on non-invasive ultrasonic evaluation of peripheral arteries.

BACKGROUND: Recently, high-frequency transducers have been introduced in echocardiography laboratories to non-invasively evaluate peripheral arteries. Our aim was to assess the usefulness of these non-invasive vascular ultrasonic techniques in differentiating between ischemic and non-ischemic dilated cardiomyopathy. METHODS: Forty patients with dilated cardiomyopathy of uncertain origin who underwent echocardiographic examination were studied. In all patients, carotid, femoral, and brachial arteries were scanned using high-frequency transducers in order to detect atherosclerotic plaques and to measure intima-media wall thickness. Also, flow-mediated vasodilation was measured at the brachial artery. RESULTS: Of the 40 patients studied, 24 (60%) had significant coronary lesions. In patients with ischemic cardiomyopathy, carotid plaques were found more frequently (79% vs. 25%, p=0.001), and intima-media wall thickness was higher in carotid (1.14+/-0.23 vs. 0.84+/-0.20 mm, <0.001), femoral (1.21+/-0.15 vs. 0.90+/-0.17 mm, p<0.001), and brachial (0.85+/-0.11 vs. 0.68+/-0.12, p<0.001) arteries. Carotid intima-media thickness of 1 mm or more was 83% sensitive and 69% specific for the diagnosis of ischemic cardiomyopathy. The highest diagnostic accuracy for any isolated vascular finding was obtained for femoral intima-media thickness greater than 1.1 mm (83% sensitivity, 88% specificity) and for brachial intima-media thickness greater than 0.7 mm (88% sensitivity and 81% specificity). The highest sensitivity (92%) was obtained for the presence of 1 or more vascular findings, and the highest specificity (94%) for 3 or more vascular findings. CONCLUSION: Non-invasive assessment of peripheral arteries is of help in differentiating between ischemic and non-ischemic dilated cardiomyopathy. These ultrasonic techniques should be considered as complementary examinations in the evaluation of patients with dilated cardiomyopathy in echocardiography laboratories.

Journal Article↗
PubMed2005

Errors in pulmonary vein identification and ostia location in the absence of pulmonary vein imaging.

BACKGROUND: A key point in atrial fibrillation (AF) ablation is the ability to identify the pulmonary vein (PVs) and locate their ostia. OBJECTIVES: The purpose of this study was to assess the error margin of PV identification and ostia location in the absence of previous PV imaging. METHODS: This study was performed in patients referred for catheter ablation of AF. PVs were reconstructed before ablation using the CARTO system. The operator tagged the superior and inferior edges of the PV ostia before and after examining the corresponding PV angiograms. The distances between the tagged PV ostia were measured using CARTO software. RESULTS: A total of 105 location estimations of 54 PVs were analyzed. The location of PV ostia without angiography deviated from the angiographic PV ostia by a median of 13 mm (95% confidence interval = 11-14 mm; P < .0001). In 84 of the 105 estimations (80%), wrong tagging was performed inside the PV. A multiple logistic regression revealed that, at sites displaying PV potentials, the left atrial potential amplitude was an independent predictor of location at the angiographic PV ostium (odds ratio 24 [95% confidence interval = 3.7-227] per 1-mV increase). Receiver operator characteristic analysis set the optimal cutoff level at 0.7 mV. Use of this criterion improved the accuracy of PV ostium location by 4 mm (95% confidence interval = 1-6 mm; P = .005). CONCLUSION: Attempts at PV identification and ostia location in the absence of previous PV imaging are subject to a broad error margin.

Adult↗
PubMed2005

Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting.

BACKGROUND: Although patients undergoing coronary stenting routinely receive dual antiplatelet treatment to reduce the risk of stent thrombosis, this undesired event still occurs. A suboptimal response to clopidogrel treatment (low responders) has been suggested to contribute to stent thrombosis. In the present study, platelet function profiles were assessed in patients undergoing coronary stenting receiving a standard 300-mg clopidogrel loading dose with the aim to identify low clopidogrel responders. MATERIALS AND METHODS: Platelet aggregation was assessed by light transmittance aggregometry following 6 microM ADP stimuli in 48 patients before and 10 min, 4 and 24 h after receiving clopidogrel front-loading. Patients having > or =40% inhibition of platelet aggregation 24 h after clopidogrel administration were defined as normal responders, whereas those having <40% inhibition were low responders. Glycoprotein (GP) IIb/IIIa activation and P-selectin expression were assessed by whole blood flow cytometry following 2 microM ADP stimuli at the same time points. Platelet function profiles were compared between normal and low clopidogrel responders. RESULTS: Twenty-seven patients (56%) were normal responders and 21 (44%) low responders. Baseline GP IIb/IIIa activation was higher in low responders (74.6+/-16.6% vs. 58.2+/-24.5%, p=0.03). Although GP IIb/IIIa activation reduced following clopidogrel front-loading in both groups, it remained increased among low responders at 24 h (58.6+/-21.3% vs. 40.2+/-28.7%, p=0.05) and during the overall study time course (p=0.02). There were no differences in P-selectin expression. CONCLUSIONS: A considerable proportion of patients have an early suboptimal response to a 300-mg clopidogrel loading dose. An increased GP IIb/IIIa activation before intervention may identify this group of patients suggesting the use of a more aggressive antithrombotic treatment in these individuals.

Aged↗
PubMed2005

Effect of clopidogrel on the expression of inflammatory markers in rabbit ischemic coronary artery.

Inflammation and platelet activation are critical phenomena in the setting of acute coronary syndromes. Platelets may contribute to increase ischemic injury by enhancing the inflammatory response of leukocytes and endothelial myocardial cells. Pharmacological inhibition of platelet activation prevents ischemic complications in patients with coronary diseases. Agents directed against the integrin glycoprotein IIb/IIIa (GP IIb/IIIa) receptor not only inhibit platelet aggregation but also have been demonstrated to limit the inflammatory response in acute coronary syndromes. The question then raised is if the inhibition of platelet activation by other mechanisms than the blockade of GP IIb/IIIa may also exert anti-inflammatory effects. The aim of the present study was to analyze if clopidogrel may exert anti-inflammatory effects during the acute phase of myocardial infarction. A ligature was placed around the left anterior descending coronary artery of New Zealand White rabbits. After 15 min of ischemia, the myocardium was reperfused and the ischemic coronary artery was isolated 24 h after the ischemia. A group of ischemic rabbits was given a single oral dose of clopidogrel (20 mg kg(-1)) just after the arterial occlusion and the animal was recovered. Sham-operated animals served as control. P-selectin expression was significantly increased in infarcted rabbits with respect to control rabbits. Clopidogrel administration reduced P-selectin expression with respect to untreated infarcted rabbits. CD40 ligand and tissue factor expression was increased in the ischemic coronary artery and reduced after clopidogrel administration. Clopidogrel also protected endothelial nitric oxide synthase protein expression in the ischemic coronary artery, a protein that has been found downregulated under inflammatory conditions. In conclusion, inhibition of platelet activation by clopidogrel exerted anti-inflammatory effects on the ischemic coronary artery.

Animals↗
PubMed2005

Effect of C-reactive protein on Fcgamma receptor II in cultured bovine endothelial cells.

The major CRP (C-reactive protein) receptor on leucocytes has been identified as the low-affinity IgG receptor Fcgamma receptor II (CD32). Our aim was to assess whether inflammation may modify the presence of the CD32 receptor in BAEC (bovine aortic endothelial cells). Confocal microscopy experiments showed a weak expression of the CD32 receptor in control BAEC that was slightly increased by 10 microg/ml CRP. Incubation of BAEC with TNF-alpha (tumour necrosis factor-alpha) did not modify the fluorescence signal of CD32. Addition of CRP to TNF-alpha-incubated BAEC enhanced the fluorescence signal of the CD32 receptors. The CD32 receptors showed a perinuclear cytoplasmic localization in BAEC. An alteration of the NO (nitric oxide)-dependent vasorelaxation has been defined as endothelial dysfunction. Endothelial dysfunction has been associated with the presence of superoxide anion and with a reduction in the expression of the eNOS (endothelial NO synthase). A concentration of CRP similar to that detected in patients with cardiovascular risk (10 microg/ml) failed to modify the generation of superoxide anion stimulated by TNF-alpha. Western blot experiments showed that TNF-alpha decreased the expression of the eNOS protein, which was partially protected by treatment with 10 microg/ml CRP. The protective effect of 10 microg/ml CRP on eNOS expression in TNF-alpha-incubated BAEC was prevented by an antibody against CD32 receptors. In conclusion, the present results suggest that, although CRP has been associated with inflammation, CRP may protect the expression of eNOS protein against pro-inflammatory mediators such as TNF-alpha.

Animals↗
PubMed2005

Proteomic approach to identify changes in protein expression modified by 17beta-oestradiol in bovine vascular smooth muscle cells.

The aim of the present study was to use proteomics to analyse modifications in the level of expression of different proteins in BVSMCs (bovine vascular smooth muscle cells) incubated in the absence and presence of 17beta-oestradiol. By using two-dimensional electrophoresis with a pH range of 4-7, we identified several areas on the gels in which the level of expression of proteins were different between control BVSMCs and cells incubated for 24 h with 17beta-oestradiol. Changes in several isoforms of alpha-enolase, HSP60 (heat-shock protein 60), vimentin and PDI (protein disulphide-isomerase) were observed in BVSMCs. The expression of alpha-enolase isoform 1 was enhanced after 17beta-oestradiol treatment. The expression of HSP60 isoform 3, vimentin isoforms 2 and 3 and caldesmon was reduced by 17beta-oestradiol. Finally, the expression of PDI isoforms was reduced by 17beta-oestradiol. In summary, 17beta-oestradiol modified the expression of isoforms of proteins associated with smooth muscle cell proliferation (alpha-enolase, vimentin and HSP-60), cell contraction (vimentin and caldesmon) and cell redox modulation (PDI). These findings confirm that 17beta-oestradiol may modulate a wide range of signalling pathways in vascular smooth muscle cells.

Animals↗
PubMed2005

Stent-based delivered anti-proliferative drugs in the prevention of coronary stent restenosis.

Coronary stents are currently used in most percutaneous coronary interventions, since they have demonstrated to reduce restenosis and allow to solve threatened closure after balloon angioplasty. Despite these beneficial effects, restenosis remains as the main limitation of percutaneous coronary interventions even with the use of coronary stents. In the last 3 years, some coronary stents eluting anti-proliferative drugs have demonstrated to dramatically reduce the risk of restenosis. By November 2004, two different types of antiproliferative drugs eluted by coronary stents are commercially available: sirolimus (rapamycin) and paclitaxel. The mechanisms, clinical evidence, as well as the remaining limitations of these drug-eluting stents are reviewed. The current knowledge of other anti-proliferative drugs that are currently under investigation is also reviewed.

Cell Proliferation↗
PubMed2005

Platelet function profiles in patients with type 2 diabetes and coronary artery disease on combined aspirin and clopidogrel treatment.

To assess platelet function profiles in diabetic and nondiabetic patients on aspirin and clopidogrel therapy, two patient populations were included to investigate the 1) acute effects of a 300-mg clopidogrel loading dose (group 1, n = 52) and 2) long-term effects of clopidogrel (group 2, n = 120) on platelet function in diabetic compared with nondiabetic patients already on aspirin treatment. Patients were stratified according to the presence of type 2 diabetes. Platelet aggregation was assessed using light transmittance aggregometry (groups 1 and 2). Platelet activation (P-selectin expression and PAC-1 binding) was determined using whole-blood flow cytometry (group 2). Clopidogrel response was also assessed. In group 1, platelet aggregation was significantly increased in diabetic (n = 16) compared with nondiabetic (n = 36) patients at baseline and up to 24 h following a 300-mg loading dose (P = 0.005). In group 2, platelet aggregation and activation were increased in diabetic (n = 60) compared with nondiabetic (n = 60) subjects (P < 0.05 for all platelet function assays). Diabetic subjects had a higher number of clopidogrel nonresponders (P = 0.04). Diabetic patients have increased platelet reactivity compared with nondiabetic subjects on combined aspirin and clopidogrel treatment. Reduced sensitivity to antiplatelet drugs may contribute to the increased atherothombotic risk in diabetic patients.

Aged↗
PubMed2005

Usefulness of real-time 3-dimensional echocardiography in the assessment of infective endocarditis: initial experience.

OBJECTIVE: Our aim was to provide an initial description of the usefulness of real-time 3-dimensional (3D) echocardiography when evaluating patients with infective endocarditis. METHODS: For this purpose, we describe 3 cases in which the usefulness of real-time 3D echocardiography is shown. RESULTS: Better definition of the morphologic characteristics of the vegetation and valvular apparatus was achieved with real-time 3D echocardiography. Furthermore, the information provided by the real-time 3D echocardiogram to the surgical team was accurate and direct because it was not based on detailed verbal information for performing a 3D mental reconstruction but was a simple image similar to what would be found in the operating room. In all cases, the information provided by the real-time 3D echocardiography was confirmed during surgery. CONCLUSIONS: Real-time 3D echocardiography is an important tool for aiding diagnosis or for fine tuning a suspected diagnosis when traditional echocardiography is not completely clear for both medical and surgical decision making.

Aged↗
PubMed2005

Long-term outcome of patients with proximal left anterior descending coronary artery in-stent restenosis treated with a second percutaneous procedure.

Patients with in-stent restenosis involving the proximal segment of the left anterior descending coronary artery are frequently sent for surgical revascularization. We studied the long-term (3.3 +/- 2.8 years) outcome of 123 patients with in-stent restenosis involving the proximal left anterior descending coronary artery who were treated with a second percutaneous procedure. Cumulative survival rate, probability of being alive and free from surgical revascularization, and probability of being alive and free from new revascularization procedures was 98.3 +/- 1.2%, 92.8 +/- 2.5%, and 82.2 +/- 3.6% at 1 year, and 95.2 +/- 2.5%, 88.5 +/- 3.4%, and 76.9 +/- 4.3% at 3 years, respectively. Thus, in patients with in-stent restenosis involving the proximal left anterior descending artery, a second percutaneous procedure is a feasible and safe long-term strategy, with few patients ultimately requiring surgical revascularization.

Adult↗