Choong Won Goh

Long-Term Clinical Outcomes and Stent Thrombosis of Sirolimus-Eluting Versus Bare Metal Stents in Patients with End-Stage Renal Disease: Results of Korean Multicenter Angioplasty Team (KOMATE) Registry

BACKGROUND There are still controversies about long-term clinical outcomes of sirolimus-eluting stents (SES) versus bare metal stents (BMS) implantation in patients with end-stage renal diseases (ESRD). OBJECTIVE To compare long-term outcomes in patients with (ESRD) following SES versus BMS implantation. METHODS Between March 2003 and July 2005, a total of 54 patients (80 lesions) with ESRD undergoing SES implantation [SES-ESRD] were enrolled and compared with 51 patients (54 lesions) with ESRD receiving BMS during the same periods [BMS-ESRD] in the Korean Multicenter Angioplasty Team Registry. The primary outcome was the composite of death, myocardial infarction (MI), or any stent thrombosis (ST) according to the Academic Research Consortium definition during a 3-year follow-up. RESULTS The cumulative 3-year rate of composite of death, MI, or ST of the SES-ESRD group (24%) was nearly similar with that of the BMS-ESRD group (24%, P = 1.000). The 3-year rates of death (26% vs. 24%, P = 0.824) or MACE (37% vs. 43%, P = 0.331) in the SES-ESRD did not differ significantly from those in the BMS-ESRD. However, the SES-ESRD showed a sustained lower 3-year TVR rate (9%), compared with BMS-ESRD (24%, P = 0.042). The rate of any ST in SES-ESRD was not significantly higher than that in the BMS-ESRD (17% vs. 14%, P = 0.788). There was no significant difference in the rate of late or very late ST between SES-ESRD (15%) versus BMS-ESRD group (10%, P = 0.557). CONCLUSIONS SES did not increase the risks for death, MI, or any ST in patients with ESRD during the long-term follow-up, compared with BMS.

EFFICACY OF DIRECT STENTING WITHOUT PREDILATION DURING PERCUTANEOUS CORONARY INTERVENTION IN ACUTE MYOCARDIAL INFARCTION- A RANDOMIZED TRIAL EVALUATING MICROVASCULAR DYSFUNCTION WITH INDEX OF MICROCIRCULATORY RESISTANCE

Results: A total of 35 patients were randomized after exclusion of patients not suitable for stenting, Direct stenting strategy was feasible in 16 of patients among the initially randomized 17 pts (DS group) and compared to 19 patients with stenting after balloon predilation (PB group). There were no signiicant differences in age, sex, traditional risk factors, pain-to-treatment time, use of Glycoprotein IIb/IIIa Inhibitor. Infract location was more anterior in PB group (73.7%) than DS group (37.5%). Final TIMI grade 3 low (97.3% vs 78.9 %, p=0.04), inal TMP grade 2 or 3 (76.8% vs 64.2%, p=0.19), and average ST-segment resolution after the procedure (65.3% vs 54.3%, p=0.08), and peak CK-MB level (178 vs. 154 mg/ dL, p=0.25) were comparable between DS and PB group, but showed results favorable to DS group. IMR was signiicantly lower in DS group than PB group (22.6 vs. 32.6 mmHg∙sec, p=0.034). At one month, a cardiac death had occurred in 0 % in the DS group and 5.3 % in the PB group (p = 0.40). Conclusion: The DS without predilation after TA during primary PCI is safe and more effective strategy to improve myocardial perfusion than conventional aspiration thrombectomy. This preliminary report lends the support to the use of DS during the TA of acute STEMI favored by the low cost.