Cheng Wanjun

Prolonged Dual Antiplatelet Therapy Improves Clinical Outcomes in High-risk Patients Implanted with Sirolimus-eluting Stents

Although a science advisory recommending 12 months of dual antiplatelet therapy after drug‐eluting stents implantation was published recently, the optimal duration of dual antiplatelet therapy has not yet been precisely determined.

e0508 Comparative analysis of different strategy for revascularization on effency in old woman diabetic patients with complex coronary disease

Objectives To evaluate and analysis the clinical efficacy and prognosis of two different strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and coronary artery bypass graft (CABG) in old woman diabetic patients with complex coronary disease. Background Elder, Female and Diabetic is markeble risk factor for poor prognosis after PCI and CABG. Which strategy of revascularization (PCI vs CABG) and the influence factor that could promote the choice of strategy for revascularization may be result in better outcome is uncertain in these patients. Further evaluations in adequately data are awaited to confirm the clinical benefit of two strategy. Methods 523 female patients whose age were above 75 years old with DM, multivessel disease underwent PCI (206) or CABG (317) were included studied. The choice of revascularization was dependent on clinical baseline and procedural characteristics of patients and/or physician recommendation. Major adverse cardiac events (MACE) included death, myocardial infarction and repeat coronary revascularization. Results MACE rates at 1 year is equivalent between CABG and PCI (2.1% vs 4.2% (OR 1.8; p>0.5). There was a similar risk of the combined endpoints of death (1.5% vs 2.8%), myocardial infarction (1.2% vs 1.6%) and cerebrovascular events (1.1% vs 2.3%) at 1 year, but the risk of target vessel revascularisation (TVR) was significantly higher (1.8% vs 7.8%, p<0.01). Compared with PCI patients, the lesions seem more complex. the prevalence of calcified lesions, total occlusion, collateral circulation were higher in CABG patients (p<0.01). The number of the diseased vessels was the only independent predictors of type of revascularization (PCI vs CABG). Conclusions PCI with DES placement was safe compared to CABG as a type of revascularization in elder female patients with DM and MVD at 1-year. A clinical strategy for revascularization by PCI or CABG should be carefully assessed.

e0510 Relation between clopidogrel resistance and inflammation facor in patients after coronary stenting

Objective To observe the serum levels of inflammatory cytokines in patients with clopidogrel resistance underwent PCI. Methods Platelet aggregation (PAG) induced with ADP were detected in 593 patients with unstable angina pectoris and had received coronary stenting. All patients were divided into clopidogrel resistance (CLR) group (n=333) and normal response group (n=260) according to PAG. At the same time, perpheral blood sample of all the patients were taken before, 24 h, 1 week and 1 month after implanting stents. The levels of C-reactive protein (CRP), P-selection and soluble fragment of CD40 ligand (sCD40L) in these patients were detected by enzyme linked immunosorbent assay. Results The incidence of clopidogrel resistance in 24 h, 1 week and 1 month after PCI was 35.5%, 26.9% and 19.3%. The levels of CRP (8.8±2.5 mg/dl at 24 h, 5.3±2.5 mg/dl at 1 week), P-selection (73.8±34 ng/ml at 24 h, 70.5±31.6 ng/ml at 1 week and 66.4±22.3 ng/ml at 1 month) and sCD40L (7.7±2.3 ng/ml at 24 h)had significant difference compared with the levels before and normal group (p<0.05). The CLR at 30 days after stent implanting was significantly correlated with the level of P-selection (r=1.334) and smoking (r=1.053). Conclusion The levels of CRP, P-selection and sCD40L of in some patient after undergoing coronary stenting increased and may correlated with clopidogrel resistance. The levels of P-selection and smoking were the predictor for clopidogrel resistance.

e0515 The value of examination of forearm artery using Doppler ultrasound before trans

Objective To explore the value of examination of fore arm artery using Doppler ultrasound before transradial coronary intervention (TRI). Methods Consecutive patients undergoing elective TRI were screened. Including criteriors were as follows: positive Allens test result of right radial artery (RRA). The primary endpoints included the procedural success rate and incidence of vascular related complications. The secondary endpoints were: the average diameter of fore arm diameter and anatomic variations of approach. Results A total of 1863 patients were eligible and assigned to ultrasound group (931 cases) and convention group without ultrasound examination (932 cases). The baseline clinic characteristics in two groups were comparable. 181 cases of anatomic variation in RRA approach were detected before procedure. Among these, approach in 13 cases changed to other routes from RRA. The procedural success rate in ultrasound group and convention group was similar (98.0% vs 97.2%, p=0.292). The incidence of vascular complications in ultrasound group was significantly lower than convention group (8.7% vs 11.6%, p=0.039). Regarding artery perforation and radial artery occlusion, the incidences of those in ultrasound group occurred less frequently (p=0.025 and 0.028, respectively). Conclusions Examination of fore arm artery using Doppler ultrasound could not only detect anatomic variations and reduce vascular complication effectively, but also be helpful to selective suitable approach and instruments.

e0490 Safety and feasibility of transradial coronary angiography at the outpatient clinic

Objective To evaluate the safety and feasibility of transradial coronary angiography at the outpatient clinic. Methods From February, 2008 to June, 2008, 100 outpatients who received transradial coronary angiography in Anzhen Hospital were included in this analysis, and 100 inpatients who underwent coronary angiography were selected as control group. Primary endpoints included success rate, percentage of angiographic catheter use with different diameters, adverse events during the procedure (such as death, malignant arrhythmia, acute myocardial infarction, coronary artery spasm, coronary artery dissection, perforation or occlusion, etc.) and after the procedure (such as death, acute myocardial infarction, upper limb haematoma, osteofascial compartment syndrome, radial artery pseudoaneurysm or occlusion, etc.). Results The success rate (100% vs 100%), procedure duration time (12.5±3.4) min vs (10.8±3.6) min, p =0.517) and exposition time (4.3±1.0) min vs (4.1±1.0) min, p =0.629) were similar between the outpatient and inpatient groups. Radial and coronary artery spasm were the main adverse events during the angiography, and haematoma was the main adverse event after the angiography. There were no significant differences of adverse events between the 2 groups. the total cost of the outpatient group was significantly lower than the inpatient control group (4012±238) yuan vs (5329±371) yuan, p<0.01). Expenditure including chemical tests, medicine, nursing care, Room & Board all decreased significantly. Conclusion Transradial coronary angiography application at the outpatient clinic was safe and feasible for stable patients, and this procedure could decrease the medical expenditure and shorten the admission time.

e0514 The safety and feasibility of repeated percutaneous transradial coronary intervention in the same route

Background The radial approach has been increasingly used as an alternative to femoral access. And more procedures of repeated transradial coronary intervention (r-TRI) are performed. Few data about r-TRI has been obtained. Therefore, we tried to investigate the safety and feasibility of repeated transradial coronary intervention (r-TRI) in the same route. Methods A total of 423 consecutive eligible patients undergoing repeated TRI were enrolled in r-TRI group, and 846 patients with initial TRI were assigned to i-TRI group in a 2- to-1 ratio matched by ages and gender. The primary endpoint included the success rate of procedure and incidence of vascular related complications. Results The baseline clinical characteristics in two groups were comparable. The success rate of procedure in r-TRI and i-TRI was similar (96.0% vs 97.5%, p=0.130). In subgroup analysis (coronary angiography only or angiography with percutaneous coronary intervention), the similar result was also observed. The puncture numbers and incidence of radial artery spasm in r-TRI group were significant higher than i-TRI group (p=0.034 and p<0.001, respectively). The other procedural outcomes in two groups were identical. With respect to the incidence of overall vascular related complication and independent event, there were no significant difference in spite of higher incidence in r-TRI group (1.2% vs 0.7%, p=0.521). The patients in i-TRI group had more comfortable feeling than r-TRI group (p<0.001). Conclusions Repeated TRI produces an equal success rate and a lower vascular complication when compared to initial TRI. It should be considered as an acceptable and safe procedure.